Clusters in Infant Environmental Factors Influence School-Age Children's Vegetable Preferences in Japan.

It remains unclear how the various environmental factors are combined in practice to influence vegetable preferences in school-aged children. This study aimed to clarify the environmental factors during infancy and their association with vegetable preference in school-aged children. To find clusters of early childhood environmental factors, we conducted a factor analysis on 58 items related to early childhood environmental factors and a k-means cluster analysis using the factors obtained. The association of the extracted factors and clusters with vegetable preferences was assessed by multiple regression analysis. Twelve factors relating to vegetable eating, cooking and harvesting experience, and parental attitudes were extracted by factor analysis. Three clusters, "low awareness of experiences", "high awareness" and "low positive encouragement", were then extracted. In the multiple regression analysis, all 12 factors were found to be associated with vegetable preferences. Furthermore, it was found that the "high awareness" group had a significantly higher score for vegetable preference than the "low awareness of experiences" group (ß = 0.56, 95% CI: 0.37-0.74). Thus, the study found that environmental factors during infancy, in isolation and combination, influenced vegetable preferences in school-aged children. Assessing the combination of various environmental factors during infancy may contribute to a better understanding of future vegetable preferences.

Beyond intensive mothering: Racial/ethnic variation in maternal time with children.

Despite substantial evidence that racial/ethnic minority communities exhibit distinct mothering practices, research on racial/ethnic differences in how mothers spend time with their children is scant. Using the 2003-2019 American Time Use Survey (N = 44,372), this study documents variations in the amounts of childcare and copresent time spent in various activities with residential children aged 0-17 across White, Black, Latina, and Asian mothers. The results show that racial/ethnic differences in maternal time spent with children are partly due to socioeconomic differences but still exist when these factors are held constant, indicating patterns that reflect each minority community's mothering norms. Compared to mothers in other groups, Black mothers spend more copresent time with children in religious activities, although less in terms of the total amount of time. Latina mothers spend more copresent time with elementary-school-age children while engaging in daily routines. Asian mothers spend more time teaching and eating with elementary-school-age or younger children.

Home-schooling and caring for children during the COVID-19 lockdown in the UK: emotional states, systems of support and coping strategies in working mothers.

Introduction: We examined the experience of the intensification of home-schooling and/or childcare in working mothers in the United Kingdom during the first national COVID-19 lockdown. Our focus was on understanding how mothers dealt with this challenging period both emotionally and practically. Methods: Eligible mothers (n = 47; Mage = 39.6) participated in an anonymous online survey of openended questions. Results: Thematic analysis of responses showed that mothers found home-schooling and/or childcare to be challenging. This was particularly notable in situations where support from partners, schools, and workplaces was limited. For single working mothers, the absence of support resources was especially impactful. Mothers often felt overly stressed trying to balance work and family responsibilities, guilty for not meeting their child's needs, and were worried over their child's well-being and academic progress and over increasing work demands. Common strategies mothers used to cope with the challenges of home-schooling and/or childcare included adopting a positive outlook, implementing flexible family structures, increasing family connectedness, and negotiating alternative partnership models. Discussion: The intensification of home-schooling and/or childcare during the lockdown in the United Kingdom negatively affected maternal well-being, particularly due to limited support. These findings underscore the importance of prioritizing maternal wellbeing in post-pandemic recovery efforts. Additionally, they highlight the social dimension of maternal wellbeing and suggest a comprehensive approach to support it that includes both timely access to intervention for mental health but also implementing family-friendly work policies and offering support with childcare and children's learning as essential measures.

Disinfection and hand hygiene knowledge, attitude, and practices among childcare facilities staff during the COVID-19 pandemic in Anhui, China: a cross-sectional study.

Objective: This study aimed to investigate the knowledge, attitude, and practice (KAP) regarding disinfection and hand hygiene, along with associated influencing factors among childcare facilities staff during the COVID-19 pandemic in Anhui, and to provide information for developing disinfection and hand hygiene strategies for childcare facilities. Methods: A web-based cross-sectional study was conducted among Anhui Province residents in China in September 2020. In this study, 60 childcare facilities in two cities of Anhui Province were selected using the convenient sampling method for questionnaires. The questionnaires were distributed through a web-based platform. The disinfection and hand hygiene KAP scores among childcare facilities staff were calculated, and their influencing factors were analyzed. The accuracy rates of knowledge, attitude, and practice of behavior were calculated and analyzed. Results: A total of 1,029 participants were included in the study. The disinfection and hand hygiene knowledge, attitude and practice ranged from approximately 5 to 23, 1 to 5, 3 to 13, respectively. The score of urban areas was higher than that of rural areas. Higher education levels and more years of working were associated with higher scores. Additionally, staff who received training or supervision had higher scores than those without. The categories with the lowest knowledge accuracy rate (46.3%), lowest attitude accuracy rate (4.2%), and "always" practice rate (5.3%) among childcare facility staff were all related to the question categories concerning the appropriate range of disinfectants for use. The accuracy rates of hand hygiene knowledge and attitude among the childcare facility staff were high (83.7%-99.6%), but the "always" practice rate was in the middle range (63.0%). Conclusion: The disinfection and hand hygiene knowledge among childcare facilities staff was inadequate during the COVID-19 pandemic in Anhui. Continuous implementation of education and training, particularly in rural areas, is essential. Establishing a monitoring system to assess usage effectiveness and adverse reactions in China is critical. Interventions should focus on increasing compliance with hand hygiene practices. Further research should explore the training and intervention of disinfection and hand hygiene, the safety of disinfection measures, and more operational hand hygiene methods in childcare facilities.

Editorial: Are government early years learning and development frameworks evidence-based? A scientist's perspective.

Not all young children attend nurseries, childminders or other group settings before they start school, but many do. It is common for countries to set out a framework to guide practice for early years providers (such as nurseries) to follow. The conundrum regarding these frameworks for young children is that proving evidence of a causal link between early environments and later outcomes is very challenging scientifically. So how do governments choose what learning and development practices and goals to make mandatory for childcare providers? And is it realistic to expect early years providers to meet the legal requirements that these frameworks impose? We do not know which learning and development practices impact positively on later outcomes, and we certainly do not know if there is a one-size-fits-all approach for an early years framework that is guaranteed to work.

Family-friendly work conditions and well-being among Malaysian women.

BACKGROUND: Although participation in paid work improves women's quality of life and well-being, the health benefits decline for women with young children. Implementing family-friendly work conditions is one strategy for improving working women's well-being, especially those with competing unpaid work responsibilities. OBJECTIVE: This study investigated the extent to which accessibility and use of 11 specific family-friendly work conditions were associated with physical health, anxiety and depression in Malaysian women with young children. DESIGN: A cross-sectional design using a retrospective self-complete, anonymous, online survey was conducted between March and October 2021. METHODS: Women with a child aged 5 years or less (N = 190) completed an online survey measuring their exposure (availability and use) to 11 specific family-friendly work conditions, and their physical health, anxiety, and depression. The sample included women who were currently and recently working and with both formal and informal employment. RESULTS: After accounting for potential confounders, women who used paid maternity leave have a lower likelihood of having anxiety symptoms. CONCLUSION: Future research is needed to extend the findings from this study by over-sampling women who are informally employed and not currently working. Policy creation and development processes, including research and decision-making, should be led by and inclusive of women. For example, research funding could be allocated to 'lived experience' research that privileges the co-design of research with consumers. Based on these findings, the extent to which family-friendly work conditions fulfill their intent to improve the well-being for working women requires further critique.

Hunter-Gatherer children's close-proximity networks: Similarities and differences with cooperative and communal breeding systems.

Among vertebrates, allomothering (non-maternal care) is classified as cooperative breeding (help from sexually mature non-breeders, usually close relatives) or communal breeding (shared care between multiple breeders who are not necessarily related). Humans have been described with both labels, most frequently as cooperative breeders. However, few studies have quantified the relative contributions of allomothers according to whether they are (a) sexually mature and reproductively active and (b) related or unrelated. We constructed close-proximity networks of Agta and BaYaka hunter-gatherers. We used portable remote-sensing devices to quantify the proportion of time children under the age of 4 spent in close proximity to different categories of potential allomother. Both related and unrelated, and reproductively active and inactive, campmates had substantial involvement in children's close-proximity networks. Unrelated campmates, siblings and subadults were the most involved in both populations, whereas the involvement of fathers and grandmothers was the most variable between the two populations. Finally, the involvement of sexually mature, reproductively inactive adults was low. Where possible, we compared our findings with studies of other hunter-gatherer societies, and observed numerous consistent trends. Based on our results we discuss why hunter-gatherer allomothering cannot be fully characterised as cooperative or communal breeding.

Parenthood and neurosurgery in Europe, a white paper from the European association of neurosurgical societies' diversity in neurosurgery committee, part II - practice with children.

Introduction: In the first part of this White Paper, the European Association of Neurosurgical Societies (EANS) Diversity in Neurosurgery Committee (DC) addressed the obstacles faced by neurosurgeons when planning to have a family and practice during pregnancy, attempting to enumerate potential, easily implementable solutions for departments to be more family-friendly and retain as well as foster talent of parent-neurosurgeons, regardless of their gender identity and/or sexual orientation. Attrition avoidance amongst parent-neurosurgeons is at the heart of these papers. Research question: In this second part, we address the obstacles posed by practice with children and measures to mitigate attrition rates among parent-neurosurgeons. For the methodology employed to compose this White Paper, please refer to Supplementary Electronic Materials (SEM) 1. Materials and methods: For composing these white papers, the European Association of Neurosurgical Societies (EANS)'s Diversity Committee (DC) recruited neurosurgeon volunteers from all member countries, including parents, aspiring parents, and individuals without any desire to have a family to create a diverse and representative working group (WG). Results: In spite of the prevailing heterogeneity in policies across the continent, common difficulties can be identified for both mothers and fathers considering the utilization of parental leave. Discussion and conclusion: Reconciliation of family and a neurosurgical career is challenging, especially for single parents. However, institutional support in form of childcare facilities and/or providers, guaranteed lactation breaks and rooms, flexible schedule models including telemedicine, and clear communication of policies can improve working conditions for parent-neurosurgeons, avoid their attrition, and foster family-friendly work environments.

Transportation, childcare, lodging, and meals: Key for participant engagement and inclusion of historically underrepresented populations in the healthy brain and child development birth cohort.

Introduction: Participant recruitment and retention (R&R) are well-documented challenges in longitudinal studies, especially those involving populations historically underrepresented in research and vulnerable groups (e.g., pregnant people or young children and their families), as is the focus of the HEALthy Brain and Child Development (HBCD) birth cohort study. Subpar access to transportation, overnight lodging, childcare, or meals can compromise R&R; yet, guidance on how to overcome these "logistical barriers" is sparse. This study's goal was to learn about the HBCD sites' plans and develop best practice recommendations for the HBCD consortium for addressing these logistical barriers. Methods: The HBCD's workgroups developed a survey asking the HBCD sites about their plans for supporting research-related transportation, lodging, childcare, and meals, and about the presence of institutional policies to guide their approach. Descriptive statistics described the quantitative survey data. Qualitative survey responses were brief, not warranting formal qualitative analysis; their content was summarized. Results: Twenty-eight respondents, representing unique recruitment locations across the U.S., completed the survey. The results indicated substantial heterogeneity across the respondents in their approach toward supporting research-related transportation, lodging, childcare, and meals. Three respondents were aware of institutional policies guiding research-related transportation (10.7%) or childcare (10.7%). Conclusions: This study highlighted heterogeneity in approaches and scarcity of institutional policies regarding research-related transportation, lodging, childcare, and meals, underscoring the need for guidance in this area to ensure equitable support of participant R&R across different settings and populations, so that participants are representative of the larger community, and increase research result validity and generalizability.

Shedding and exclusion from childcare in children with Shiga toxin-producing Escherichia coli, 2018-2022.

Excluding children with Shiga toxin-producing Escherichia coli (STEC) from childcare until microbiologically clear of the pathogen, disrupts families, education, and earnings. Since PCR introduction, non-O157 STEC serotype detections in England have increased. We examined shedding duration by serotype and transmission risk, to guide exclusion advice. We investigated STEC cases aged <6 years, residing in England and attending childcare, with diarrhoea onset or sample date from 31 March 2018 to 30 March 2022. Duration of shedding was the interval between date of onset or date first positive specimen and earliest available negative specimen date. Transmission risk was estimated from proportions with secondary cases in settings attended by infectious cases. There were 367 cases (STEC O157 n = 243, 66.2%; STEC non-O157 n = 124, 33.8%). Median shedding duration was 32 days (IQR 20-44) with no significant difference between O157 and non-O157; 2% (n = 6) of cases shed for ≥100 days. Duration of shedding was reduced by 17% (95% CI 4-29) among cases reporting bloody diarrhoea. Sixteen settings underwent screening; four had secondary cases (close contacts' secondary transmission rate = 13%). Shedding duration estimates were consistent with previous studies (median 31 days, IQR 17-41). Findings do not warrant guidance changes regarding exclusion and supervised return of prolonged shedders, despite serotype changes.

Association of Spousal Social Support in Child-Rearing and Marital Satisfaction with Subjective Well-Being among Fathers and Mothers.

This study explored the association of spousal support and marital satisfaction with the subjective well-being of fathers and mothers using a mediation analysis. Data were gathered from 360 fathers and 338 mothers (aged 25-50 years). Subjective well-being was measured as an outcome using the Japanese version of the World Health Organization-Five Well-Being Index. Marital satisfaction was measured as a mediating variable using the Japanese version of the Marital Relationship Satisfaction Scale. Spousal social support (including instrumental, emotional, and appraisal support) was measured as an independent variable using four-point scales. Control variables were the father's and mother's ages, number of children, age of the youngest child, children going to nursery school or kindergarten, use of childcare services, self-evaluated low economic status, and weekday working hours. Among fathers, instrumental and emotional support had significant direct and indirect effects, with the latter mediated by the impact of marital satisfaction on subjective well-being; appraisal support had only significant indirect effects. Among mothers, instrumental support had significant direct and indirect effects; emotional and appraisal support had only significant indirect effects. Our findings indicate that social support from spouses has protective direct and indirect effects on subjective well-being among parents and suggest the need for mutual support between spouses to facilitate effective co-parenting.

Intersecting social determinants of health among patients with childcare needs: a cross-sectional analysis of social vulnerability.

INTRODUCTION: Access to childcare is an understudied social determinant of health (SDOH). Our health system established a childcare facility for patients to address childcare barriers to healthcare. Recognizing that social risk factors often co-exist, we sought to understand intersecting social risk factors among patients with childcare needs who utilized and did not utilize the childcare facility and identify residual unmet social needs alongside childcare needs. METHODS: We conducted a cross-sectional analysis of patients who enrolled in the childcare facility from November 2020 to October 2022 to compare parameters of the Social Vulnerability Index (SVI) associated with the census tract extracted from electronic medical record (EMR) data among utilizers and non-utilizers of the facility. Overall SVI and segmentation into four themes of vulnerability (socioeconomic status, household characteristics, racial/ethnic minority status, and housing type/transportation) were compared across utilizers and utilizers. Number of 90th percentile indicators were also compared to assess extreme levels of vulnerability. A sample of utilizers additionally received a patient-reported social needs screening questionnaire administered at the childcare facility. RESULTS: Among 400 enrollees in the childcare facility, 70% utilized childcare services and 30% did not. Utilizers and non-utilizers were demographically similar, though utilizers were more likely to speak Spanish (34%) compared to non-utilizers (22%). Mean SVI was similar among utilizers and non-utilizers, but the mean number of 90th percentile indicators were higher for non-utilizers compared to utilizers (4.3 ± 2.7 vs 3.7 ± 2.7, p = 0.03), primarily driven by differences in the housing type/transportation theme (p = 0.01). Non-utilizers had a lower rate of healthcare utilization compared to utilizers (p = 0.02). Among utilizers who received patient-reported screening, 84% had one unmet social need identified, of whom 62% agreed for additional assistance. Among social work referrals, 44% were linked to social workers in their medical clinics, while 56% were supported by social work integrated in the childcare facility. CONCLUSIONS: This analysis of SDOH approximated by SVI showed actionable differences, potentially transportation barriers, among patients with childcare needs who utilized a health system-integrated childcare facility and patients who did not utilize services. Furthermore, residual unmet social needs among patients who utilized the facility demonstrate the multifactorial nature of social risk factors experienced by patients with childcare needs and opportunities to address intersecting social needs within an integrated intervention. Intersecting social needs require holistic examination and multifaceted interventions.

Effects of Multidisciplinary Health Promotion Program Among Children in Community Childcare Center.

In this study, the effects of a 12-month multidisciplinary education program on the health status, dietary quality, and eating habits of children and adolescents attending community childcare centers were investigated. A total of 88 participants aged 7 to 17 years from 7 community childcare centers in Gyeonggi-do were enrolled. The intervention consisted of 12 multidisciplinary education sessions covering topics such as nutrition, exercise, and psychological education. All participants received the same education, and the effectiveness of the program was evaluated by categorizing them into a high participation group (HPG) and a low participation group (LPG) based on their participation rates. After intervention, in physical activities, moderate-intensity exercise was significantly reduced in the LPG, and there was no significant difference in psychological parameters. However, notable differences were observed in nutritional data. After intervention, intakes of calorie, carbohydrate, protein, and fat were significantly increased in both groups, and in particular, the change was found to be greater in HPG. Additionally, dietary fiber intake compared to the 2015 Korean Dietary Reference Intakes was increased in both groups. Daily food intake also increased dietary fiber intake in HPG, and meat and fruit intake was increased in LPG. In the nutrition quotient, there was a significant difference in HPG's pre- and post-scores in the diversity category, and in nutrient adequacy ratio (NAR), the NAR of phosphorus was increased in both groups. The findings of this study suggest that multidisciplinary education implemented at community childcare centers primarily enhanced nutrition-related factors rather than physical activity or psychological aspects. Trial Registration: Clinical Research Information Service Identifier: KCT0002718.

Cognitive Job Demands and Sports Participation among Young Workers: What Moderates the Relationship?

Cognitive job demands are theoretically and empirically associated with sports participation in various ways. Workers may be overwhelmed by stress and fatigue from their workload and therefore refrain from sports activities, but they can also feel the need to use sports as a way to recover and detach from work. The strategy to which workers adhere can depend on workers' resources that moderate the cognitive job demands and sports participation relationship, such as educational attainment, being a parent, or having worktime and work location control. To test our expectations, we used recent information on sports participation by young working adults from the Netherlands (N = 2032). Using multinomial logistic regression modelling, we found that workers in mentally demanding jobs were more likely to participate in sports more than three times a week. In particular, workers without children reported a higher likelihood of participating in sports more than three times a week when they experienced high cognitive job demands. Among the higher-educated, workers with high cognitive job demands were less likely to participate in sports one to three times a week. We reflect on the academic and policy-related implications of our findings.

Protective role of informal social support and early childhood programs in reducing likelihood of subsequent reports of child maltreatment.

BACKGROUND: While past research has suggested the importance of informal social support and early childhood programs for the well-being of child welfare supervised families and children, little is known about whether or not these mechanisms function as protective factors for child welfare involved families and mediate the likelihood of repeat child maltreatment. OBJECTIVE: The study examined the role of informal social support and early childhood program participation in mediating the effects of initial report of child neglect on subsequent child maltreatment reports. PARTICIPANTS & SETTING: The study sample of children ages 0-6 (N = 1963) was drawn from the NSCAW-II dataset, a nationally representative longitudinal dataset of 5872 child welfare supervised children and their families. METHODS: Structural Equation Modeling was used to examine the direct and indirect pathways: from initial report of neglect to all subsequent child maltreatment reports and from initial report of neglect to all subsequent child maltreatment reports through mediating variables such as informal social support and early childhood programs. RESULTS: Results showed that informal social support plays an important role in reducing the likelihood of subsequent reports (b = -0.00, p = 0.005). One unit increase in informal social support reduced the odds of a child maltreatment re-report by 0.3 % (odds ratio for informal social support OR = 0.997). IMPLICATIONS: It is important that child welfare supervised families are supported in enhancing their informal networks with their family members and friends and expanding non-familial informal networks in the community.

Moving together or left behind? An examination of rural migrant working mothers' childcare strategies in the cities.

BACKGROUND: In China, an increasing number of rural mothers participate in urban labour markets, but little is known about their decisions regarding childcare while living in these cities. Why do some rural mothers migrate to the cities with their children, whereas others leave their children behind in the countryside? METHODS: This study analysed 1852 samples from the 2016 China Migrant Dynamic Survey of rural migrant mothers collected in the Pearl River Delta (PRD). These mothers were registered with agricultural hukou outside of the PRD and had at least one child under 18 years of age. RESULTS: The results indicated that 57.8% of these mothers migrated together with their children. Rural migrant mothers who were self-employed, had a higher level of household income on a log10 scale and had a longer duration of migration were more willing to adopt closely performing motherhood than rural migrant mothers who were not self-employed. Additionally, rural working mothers who were intra-provincial migrants and had a smaller number of children were more likely to bring their children to the cities than rural working mothers who were inter-provincial migrants. CONCLUSIONS: This study works to strengthen the understanding of rural migrant working mothers' childcare strategies, provide insights for future policy studies and contribute to evidence-based recommendations for policymakers regarding internal rural-to-urban migration, migrant women and the wellbeing of the families of migrants.

Risks, solutions and implementation of a participatory ergonomic intervention in 16 day nurseries: A process evaluation of the TOY wait-list cluster-randomized controlled trial.

More evidence-based initiatives to reduce physical work demands during childcare work to prevent ill health and promote the ability to care for the children among childcare workers are needed. In a process evaluation performed alongside a two-arm, cluster-randomized study with a waiting-list control among 16 day nurseries lasting 20-weeks that significantly reduced musculoskeletal pain-related sickness absence we investigated 1) risk factors and solutions perceived by the childcare workers, and 2) implementation of the intervention. Most of the perceived risk factors were categorized as physical (70 %) with most of the suggested solutions also being categorized as physical (61 %). The remaining risk factors were categorized as organizational risk factors (16 %) and psychosocial risk factors (13 %). The remaining solutions were distributed almost equally between the organizational (20 %) and psychosocial categories (19 %). About half (51 %) of the action plans showed high implementation success. Of 16 workshops, 100 % were delivered with a fidelity of 83 %. Average participation, exposure, responsiveness and implementation were 68 %, 56 %, 83 % and 47 %. The implementation score differed for timing of intervention but not for nursery characteristics. This study showed that complex and diverse participatory ergonomic interventions should focus on physical, organizational and psychosocial factors to have a positive effect.

Parental stress and child stimulation practices: examining associations with child developmental outcomes over time in Kenya and Zambia.

BACKGROUND: Parental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes. METHODS: The findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children's mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children's developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers' parenting stress, child stimulation practices, and child developmental outcomes. RESULTS: The findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers' stimulation practices and children's developmental outcomes were not universally supported. CONCLUSION: The findings show that improved caregiver stimulation practices are likely to improve children's developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs. TRIAL REGISTRATION: Pan African Clinical Trials Registry ( https://pactr.samrc.ac.za/ ) database (ID number: PACTR20180774832663 Date: 26/July/2018.

Tracking progress toward a climate-friendly public food service strategy: assessing nutritional quality and carbon footprint changes in childcare centers.

BACKGROUND: Public food procurement and catering are recognized as important leverage points in promoting sustainable and healthy dietary habits. This study aimed to analyze changes in nutritional quality and carbon footprint (CF) of food service in childcare centers in the City of Copenhagen from 2018 to 2022, following a new climate-friendly food strategy in 2019. The strategy has a target of decreasing the CF of municipal food service by 25% before 2025 compared to a 2018 baseline. METHODS: Key initiatives in the municipality's strategy included creating guidelines for food-service providers to reduce their CF while ensuring meal nutritional quality and providing food professionals an advisory process to develop necessary competencies. In this quasi-experimental study, food procurement data from Copenhagen's childcare centers (n = 356 [2022]) from 2018 and 2022 were combined with CF and nutrient composition data. Dietary CF and food and nutrient content were calculated per 10 MJ of energy and compared to guideline targets. Furthermore, data for 2022 were analyzed separately for institutions that had received an advisory process (n = 87) and those that had not yet (n = 269). RESULTS: On average, the CF of the food procurement decreased by 15%, mainly driven by a decrease in ruminant meat purchases (-37%). While the procurement of plant-based protein sources (pulses, nuts, seeds) increased by 25%, it was still considerably below targets. Nutrient content did not substantially change, and recommendations for calcium, iron, vitamin D, sodium, and total and saturated fat were not met in either measurement year. Institutions that had received an advisory process had a 14% lower CF in 2022 than institutions that had not. CONCLUSIONS: With the observed 15% CF reduction, Copenhagen's childcare centers are on track to reach the 25% reduction goal outlined in the municipality's food strategy by 2025. Nutritional quality was largely unchanged, but further efforts to increase especially the consumption of plant-based protein sources, while simultaneously reducing meat and animal-based fat, and maintaining sufficient dairy consumption, are needed to improve nutritional quality and reach the target CF reduction in the coming years. Providing training for food professionals could play an important role in seeing the changes through.

Factors influencing accidental food allergic reactions in schools and preschools.

BACKGROUND: Children spend a large proportion of their childhood in schools. In Ireland, there is no government policy on the management of food allergy (FA) in schools or preschool childcare settings (CCS). There is limited data worldwide on rate of accidental allergic reactions (AARs) within these settings. AIM: The aim of this paper is to report the management of FA and the incidence of AARs in Irish school or preschool CCS. METHODS: A prospective observational study was established, enrolling children aged 2 to 16 years with confirmed FA. Participants were contacted at three monthly intervals for 1 year to report AARs to food. Data pertaining to schools and preschool CCS is reported here. RESULTS: A total of 521 children (402 attending school and 119 attending preschool CCS) were enrolled. The annualised incidence of AARs in school was 4.5% (95% CI 2.6-7.0) and in preschool CCS 5% (95% CI 1.8-11.1); 6 of 7 of the nut reactions occurred in schools banning nuts. Half (3/6) of the preschool reactions were to cow's milk; 174/521 (33%) children did not provide their individualised allergy action plan (AAP). Four out of 18 (22%) AARs in school were anaphylaxis and none were administered adrenaline by school staff. CONCLUSION: The incidence of AARs in this Irish cohort was found to be equivalent to the international experience. However, many of the recorded reactions identified in this study were likely avoidable. Preparation for AARs needs optimising. The ineffectiveness of "nut bans" remains unrecognised. Promoting milk and egg allergy resolution in infancy would likely reduce preschool- and school-based reaction numbers.