[Hospital restaurants: the point of different liaison systems].
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Food Handling↗
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[Restaurant? Nutrition? Which future is possible?].
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Food Service, Hospital↗
Fast food, race/ethnicity, and income: a geographic analysis.
BACKGROUND: Environmental factors may contribute to the increasing prevalence of obesity, especially in black and low-income populations. In this paper, the geographic distribution of fast food restaurants is examined relative to neighborhood sociodemographics. METHODS: Using geographic information system software, all fast-food restaurants within the city limits of New Orleans, Louisiana, in 2001 were mapped. Buffers around census tracts were generated to simulate 1-mile and 0.5-mile "shopping areas" around and including each tract, and fast food restaurant density (number of restaurants per square mile) was calculated for each area. Using multiple regression, the geographic association between fast food restaurant density and black and low-income neighborhoods was assessed, while controlling for environmental confounders that might also influence the placement of restaurants (commercial activity, presence of major highways, and median home values). RESULTS: In 156 census tracts, a total of 155 fast food restaurants were identified. In the regression analysis that included the environmental confounders, fast-food restaurant density in shopping areas with 1-mile buffers was independently correlated with median household income and percent of black residents in the census tract. Similar results were found for shopping areas with 0.5-mile buffers. Predominantly black neighborhoods have 2.4 fast-food restaurants per square mile compared to 1.5 restaurants in predominantly white neighborhoods. CONCLUSIONS: The link between fast food restaurants and black and low-income neighborhoods may contribute to the understanding of environmental causes of the obesity epidemic in these populations.
Eating↗
Preference reversals in grading systems for retail food facilities.
The authors asked 120 university students about their willingness to dine in restaurants if those restaurants had received inspection grades of A, B, or C under three different scenarios: 1) the restaurant is one they normally dine in, 2) the restaurant has been closed for health violations but recently reopened, and 3) the restaurant has been given a score (88, 78, 68, or 58) but no grade. Using a paired-samples sign test, the authors discovered differences among the scenarios with statistical significance above 99.9 percent. Subjects were less willing to dine if a restaurant had been recently closed and were more willing to dine if only scores were given. The results indicate three cases of preference reversal from the normal order of A, B, and C: 1) subjects preferred a grade of B over A if the B restaurant had a score of 88 and the A restaurant had recently been closed; 2) subjects preferred a grade of C over B if the C restaurant had a score of 78 and the B restaurant had recently been closed; and 3) subjects preferred a score of 68 (which would earn closure in many jurisdictions) over a legitimate grade of C at a recently closed restaurant. In addition, subjects preferred a score of 88 to a grade of B and a score of 78 to a grade of C, even though those scores and respective grades are assumed to be equivalent. The study population was limited to university students, who may not necessarily represent the broader population. Similar cognitive effects have, however, been documented throughout the literature on risk perceptions. In any event, the results indicate a need for closer examination of grading systems. On the basis of preference-reversal principles, the authors propose ways to improve grading systems for retail food facilities and suggest an agenda for further research.
Adult↗
Are Americans receptive to smokefree bars?
It is not known whether the American public accepts smokefree bars and restaurants. Anticipating public displeasure with these ordinances, tobacco, liquor and restaurant industry trade associations have helped to stall efforts to pass laws curbing bar and restaurant smoking in the expectation that diminished patronage would inevitably result. This cross-sectional trend study uses data from the May 1993 and January 1999 Current Population Surveys, Tobacco Use Supplements to compare tobacco-control attitudes among American bar and restaurant workers, all other workers, smokers and nonsmokers (total n = 90,661). It was found that by 1999, smokefree workplaces were widely accepted by two-thirds of adults, with half favoring completely smokefree restaurants. Completely smokefree bars remained less popular, with nearly equal numbers (about 30%) preferring them or favoring unrestricted bar smoking. Even among bar and restaurant industry workers less than 10% favored unrestricted restaurant smoking. Greater acceptances of smokefree bars are now taking hold, especially in places like California, where acceptance rose 15% in six years, and 45% preferred them. Opponents to smokefree bars and restaurants may have underestimated the levels of support and growing acceptance of smokefree living areas now taking hold among the general public.
Alcohol Drinking↗
Ecological and socioeconomic correlates of fruit, juice, and vegetable consumption among African-American boys.
BACKGROUND: Investigators have reported that the availability of foods in local grocery stores correlated with consumption when using large geopolitical units of analysis, e.g., zip codes. Associations across smaller geopolitical units, e.g., census tracts, have not been tested, nor has this work focused on restaurant availability, child consumption, or specific ethnic groups. METHODS: This study examined whether median family income and fruit, juice, and vegetable (FJV) availability in grocery stores, restaurants, and homes in 11 census tracts correlated with FJV consumption among 11- to 14-year-old African-American Boy Scouts. FJV consumption was measured in 90 scouts using two 24-h food recalls. Instruments were developed to measure the availability of FJV at area grocery stores, restaurants, and homes where troop members resided. RESULTS: Median household income (from 1990 census) was significantly correlated with restaurant fruit availability. Significant correlations were found between restaurant juice and vegetable availability and Boy Scout reported consumption of juice and vegetables. CONCLUSION: Census tract may be a useful unit when studying restaurant, but not grocery store, FJV availability. Within a census tract, restaurant FJV availability may be a significant target for community intervention and process evaluation.
Adolescent↗
An outbreak of hepatitis A associated with green onions.
BACKGROUND: In November 2003, a large hepatitis A outbreak was identified among patrons of a single Pennsylvania restaurant. We investigated the cause of the outbreak and factors that contributed to its unprecedented size. METHODS: Demographic and clinical outcome data were collected from patients with laboratory confirmation of hepatitis A, and restaurant workers were tested for hepatitis A. A case-control study was conducted among patrons who dined at the restaurant between October 3 and October 6, 2003. Sequence analysis was performed on a 315-nucleotide region of viral RNA extracted from serum specimens. RESULTS: Of 601 patients identified, 3 died; at least 124 were hospitalized. Of 425 patients who recalled a single dining date at the restaurant, 356 (84 percent) had dined there between October 3 and October 6. Among 240 patients in the case-control study, 218 had eaten mild salsa (91 percent), as compared with 45 of 130 controls (35 percent) (odds ratio, 19.6; 95 percent confidence interval, 11.0 to 34.9) for whom data were available. A total of 98 percent of patients and 58 percent of controls reported having eaten a menu item containing green onions (odds ratio, 33.3; 95 percent confidence interval, 12.8 to 86.2). All restaurant workers were tested, but none were identified who could have been the source of the outbreak. Sequences of hepatitis A virus from all 170 patients who were tested were identical. Mild salsa, which contained green onions grown in Mexico, was prepared in large batches at the restaurant and provided to all patrons. CONCLUSIONS: Green onions that were apparently contaminated before arrival at the restaurant caused this unusually large foodborne outbreak of hepatitis A. The inclusion of contaminated green onions in large batches that were served to all customers contributed to the size of the outbreak.
Adolescent↗
A shigellosis outbreak traced to commercially distributed shredded lettuce.
In the period August 30-October 7, 1986, 347 persons in adjacent west Texas counties (Ector and Midland) contracted culture-confirmed Shigella sonnei gastroenteritis. A case-control study showed an increased risk of acquiring shigellosis in Ector County with eating at outlets of fast-food Restaurant A, and in Midland County with eating at Restaurant B or C. A second case-control study, of persons who had eaten at Ector County outlets of Restaurant A, showed an increased risk of acquiring shigellosis with eating foods containing shredded lettuce and tomatoes, which were served together (odds ratio = 68.8; 95% confidence interval 8.5-293.1). All implicated restaurants received shredded lettuce produced at one lettuce-shredding plant; two implicated restaurants did not receive tomatoes from the lot delivered to other implicated restaurants. The lettuce-shredding plant distributed shredded lettuce and intact lettuce; restaurants that received only intact lettuce were not involved in the outbreak. Investigation at the lettuce-shredding plant suggested that a food handler might have been the source of contamination and that the method of processing might have allowed cross-contamination to occur. In the laboratory, the outbreak strain of S. sonnei multiplied rapidly on shredded lettuce at 22 C and survived on refrigerated shredded lettuce for at least seven days. This outbreak, one of the largest outbreaks of Shigella infections in the United States in the last decade, indicates that a large, geographically widespread shigellosis outbreak can result from contaminated shredded lettuce that is distributed commercially.
Adolescent↗
Concurrent outbreaks of Shigella sonnei and enterotoxigenic Escherichia coli infections associated with parsley: implications for surveillance and control of foodborne illness.
In recent years, the globalization of the food supply and the development of extensive food distribution networks have increased the risk of foodborne disease outbreaks involving multiple states or countries. In particular, outbreaks associated with fresh produce have emerged as an important public health concern. During July and August 1998, eight restaurant-associated outbreaks of shigellosis caused by a common strain of Shigella sonnei occurred in the United States and Canada. The outbreak strain was characterized by unique pulsed-field gel electrophoresis patterns. Epidemiologic investigation determined that the illness was associated with the ingestion of parsley at four restaurants; at the other four restaurants, the majority of the people who contracted the illness ate parsley. Isolates from patrons in two unrelated restaurant-associated enterotoxigenic Escherichia coli (ETEC) outbreaks in Minnesota shared a common serotype and pulsed-field gel electrophoresis (PFGE) pattern. Parsley was the implicated or suspected source of both ETEC outbreaks. In each of the outbreak-associated restaurants, parsley was chopped, held at room temperature, and used as an ingredient or garnish for multiple dishes. Infected food workers at several restaurants may also have contributed to the propagation of the outbreak. The sources of parsley served in outbreak-associated restaurants were traced, and a 1,600-acre farm in Baja California, Mexico, was identified as a likely source of the parsley implicated in six of the seven Shigella outbreaks and as a possible source of the parsley implicated in the two ETEC outbreaks. Global food supplies and large distribution networks demand strengthened laboratory and epidemiologic capacity to enable state and local public health agencies to conduct foodborne disease surveillance and to promote effective responses to multistate outbreaks.
Canada↗
A stake in the business.
When Chris Sullivan and three friends opened the first Outback Steakhouse in March 1988, in Tampa, Florida, they were hoping it would be successful enough to spawn a few more and maybe some other kinds of restaurants as well. Since then, their chain of Australia-themed restaurants has grown to some 900 locations and counting-plus another 300 or so "concept" restaurants that operate from under Outback's corporate umbrella. Growth like that doesn't happen accidentally, Sullivan says, but it certainly wasn't part of the original plan. In this first-person account, Outback's chairman describes the organization's formula for growth and development, which is consciously rooted in the founders' belief in putting people first. They've created an organizational model in which field managers make most of the decisions, garner the rewards, and live with the consequences. Specifically, the founders believe that the most effective way to make customers happy is to first take care of the people who cook for them, serve them, and supervise operations at the restaurants. Outback servers have fewer tables to worry about than those at other restaurant chains; the cooks have bigger, cooler, better-equipped kitchens; and the supervisors work their way up the ranks toward an equity stake in the restaurant or region they run. There are no administrative layers between field managers and the executives at headquarters. Giving employees good working conditions and the chance to become owners has proved to be good business: Turnover among hourly employees is low, and Outback and its subsidiaries opened 120 restaurants last year, increasing sales by 20.1%. The company must grow in order to keep offering career opportunities to its workers; in turn, those opportunities ensure that Outbackers remain committed to making customers happy and the company successful.
Career Mobility↗
Promoting nutrition in commercial foodservice establishments: a realistic approach.
Americans are eating out an average of 3.7 times per week and are spending almost 40% of their food dollar doing so. A Gallup Survey shows about 39% of consumers claim to have improved their eating habits while eating out, but restaurant patrons are most concerned about nutrition when dining out on a routine visit or while in a family-style restaurant. Restaurant patrons are also now more likely to order lower sodium meals, small-size portions, and lower calorie entrées. Although the opportunity to promote nutrition in the foodservice setting exists, restaurant chefs and managers often lack the background to take advantage of it and could benefit from the services of qualified nutrition professionals. Dietitians could assist in identifying menu items appropriate for nutrition promotion, recipe development, and staff training. However, a realistic approach must be maintained, and the following facts should be kept in mind: Nutritious restaurant fare should blend with the theme of the menu and be promoted primarily on its sensory attributes. Nutrition in restaurants is best received when promoted generally and within the scope of health and wellness. Descriptive menu items should be carefully used. A restaurant consultant should be current on controversial food and nutrition trends. The wait staff should be properly trained.
Dietetics↗
Outbreak of viral gastroenteritis due to a contaminated well. International consequences.
CONTEXT: Small round-structured viruses (SRSVs) are known to cause viral gastroenteritis, but until now have not been confirmed in the implicated vehicle in outbreaks. OBJECTIVE: Investigation of a gastroenteritis outbreak. DESIGN: After applying epidemiologic methods to locate the outbreak source, we conducted environmental and laboratory investigations to elucidate the cause. SETTING: Tourists traveling by bus through Alaska and the Yukon Territory of Canada. PARTICIPANTS: Staff of a restaurant at a business complex implicated as the outbreak source, convenience sample of persons on buses that had stopped there, and bus employees. MAIN OUTCOME MEASURES: Odds ratios (ORs) for illness associated with exposures. Water samples from the restaurant and stool specimens from tourists and restaurant staff were examined by nucleic acid amplification using reverse transcription polymerase chain reaction and sequencing of viral amplification products. RESULTS: The itineraries of groups of tourists manifesting vomiting or diarrhea were traced back to a restaurant where buses had stopped 33 to 36 hours previously. Water consumption was associated with illness (OR, 5.3; 95% confidence interval [CI], 2.3-12.6). Eighteen of 26 employees of the business complex were ill; although not the index case, an employee ill shortly before the outbreak lived in a building connected to a septic pit, which was found to contaminate the well supplying the restaurant's water. Genotype 2/P2B SRSV was identified in stool specimens of 2 tourists and 1 restaurant employee. Stools and water samples yielded identical amplification product sequences. CONCLUSIONS: The investigation documented SRSVs in a vehicle epidemiologically linked to a gastroenteritis outbreak. The findings demonstrate the power of molecular detection and identification and underscore the importance of fundamental public health practices such as restaurant inspection, assurance of a safe water supply, and disease surveillance.
Base Sequence↗
[Principles and indications for prosthetic restorations].
Once it has been explained and defined what a prosthesis and what the masticatory apparatus and its function are, the author defines the three principles of a prosthetic restauration: --Any prosthetic restauration should be conceived and realized only after a complete study of the odontostomatognathic system. --Any prosthetic restauration must reestablish the health of the masticatory apparatus. --Any prosthetic restauration must assist in the conservation of the remaining teeth. Six corollaries are deduced from those principles and are equally defined and analysed. The indication of a prosthetic restauration comes from those principles and their corollaries. A possible fixed restauration is to be studied first, then comes the possibility of a semifixed construction. When both those solutions are impossible, the planning of a removable prosthesis, even simple, must be studied with method. This prosthesis must be composed of a cast metallic framework. If the planned prosthetic restauration can not be beneficial to the whole masticatory apparatus, it is better to renounce to do it.
Biomechanical Phenomena↗
Attitudes and experiences of restaurateurs regarding smoking bans in Adelaide, South Australia.
OBJECTIVES: To determine compliance with a voluntary code of practice (VCP) for restricting smoking in restaurants and to canvass the attitudes of restaurateurs towards tougher smoking restrictions. DESIGN: Cross-sectional survey conducted in 1996 using a telephone questionnaire. SETTING: Metropolitan restaurants and cafes in Adelaide, South Australia. PARTICIPANTS: 276 (86.8%) of a sample of randomly selected owners and managers. MAIN OUTCOME MEASURES: Restaurant non-smoking policies, reported and anticipated change in business, and restaurateurs' attitudes towards smoking restrictions. RESULTS: 26.8% of restaurants had a total smoking ban; 40.6% restricted smoking some other way; and 32.6% permitted unrestricted smoking. Only 15.1% of restaurants with a ban or restrictions had used the VCP to guide the development of their policy, and only half of these were complying with it. Although 78.4% of those with bans and 84.4% of those with restrictions reported that their non-smoking policy had been associated with either no change or a gain in business, only 33.3% of those allowing unrestricted smoking expected that this would be the case, if they were to limit smoking. A total of 50.4% of restaurateurs, including 45.3% of those with no restrictions, agreed that the government should ban smoking in all restaurants. CONCLUSIONS: The VCP made an insignificant contribution to adoption of non-smoking policies, and compliance with the code was poor. Despite concerns about loss of business, there was considerable support for legislation which would ban smoking in all dining establishments.
Attitude to Health↗
A multifocal outbreak of hepatitis A traced to commercially distributed lettuce.
From February 1 through March 20, 1988, 202 cases of hepatitis A were reported in and around Jefferson County, Kentucky. The epidemic curve indicated a common-source exposure. However, there was no apparent single source of exposure from a restaurant, or community gathering; nor was there a geographic clustering by residence. Cases were mainly adults 20-59 years old (89 percent); 51 percent were female. A case-control study using neighborhood controls found that factors associated with hepatitis A were: having eaten downtown (odds ratio [OR] = 4.0) and having dined at any one of three restaurants (OR = 21.0). Case-control studies of patrons of two of these restaurants found that eating green salad was strongly associated with acquiring hepatitis A: OR = 11.6 and OR = 4.4. The three implicated restaurants accounted for 71 percent of the cases. All three restaurants were supplied by the same fresh produce distributor; however, investigation suggested that contamination most likely occurred prior to local distribution. This outbreak of hepatitis A is the first in the United States apparently associated with fresh produce contaminated before distribution to restaurants, and raises important public health issues regarding the regulation of fresh produce.
Adult↗
Hepatitis A: report of a common-source outbreak with recovery of a possible etiologic agent. I. Epidemiologic studies.
From the end of October to the end of December 1973, an epidemic of hepatitis A affected 40 students at a state university, 11 employees of two restaurants, and 11 other residents in a southwestern metropolitan community. Two distinct epidemic waves of illness occurred, and investigation implicated two local restaurants as sources of infection, one for each epidemic wave. An index patient who prepared food was identified at each restaurant, and the two restaurants were linked by the fact that the index patient who worked at the second restaurant had patronized the first restaurant. Foods implicated as vehicles of transmission included 'guacamole,' green salad, spaghetti, and hamburger. The findings represent a rare example of a 'double' common-source outbreak with two distinct epidemic waves related to two separate eating establishments.
Arizona↗
Fate of Campylobacter jejuni in butter.
An outbreak of Campylobacter enteritis was associated with a restaurant in Louisiana during the summer of 1995. Thirty cases were identified, and four required hospitalization. Campylobacter jejuni was isolated from the patients, and epidemiologic studies revealed illness associated with eating garlic butter served at the restaurant. Three batches of garlic butter prepared by the restaurant associated with the outbreak and a C. jejuni isolate obtained from a patient involved in the outbreak were used for studies to determine the fate of C. jejuni in garlic butter. Studies also were done to determine the efficacy of the heat treatment used by the restaurant to prepare garlic bread to kill C. jejuni. Garlic butter was inoculated with approximately 10(4) and 10(6) CFU/g of C. jejuni and held at 5 or 21 degrees C. Results revealed that the survival of C. jejuni differed greatly, depending on the presence or absence of garlic. At 5 degrees C, C. jejuni populations decreased to an undetectable level (<10 CFU/g) within 3 h for two batches and within 24 h for another batch. In contrast, C. jejuni could survive at 5 degrees C for 13 days in butter with no garlic. At 21 degrees C, C. jejuni populations decreased to an undetectable level within 5 h for two batches and to 50 CFU/g in 5 h for another batch. In contrast, C. jejuni was detected at 500 CFU/g at 28 h after inoculation but was undetectable at 3 days in butter with no garlic held at 21 degrees C. The heating procedure (135 degrees C, 4 min) used to make garlic bread by the implicated restaurant was determined not to be sufficient for killing C. jejuni, with the internal temperature of the buttered bread after heating ranging from 19 to 22 degrees C. This study revealed that C. jejuni can survive for many days in refrigerated butter, but large populations (10(3) to 10(5) CFU/g) are killed within a few hours in butter that contains garlic. Furthermore, the heat treatment used by the restaurant to melt garlic butter in making garlic bread was not adequate to kill C. jejuni.
Animals↗
Comparisons of microbiological evaluations of selected kitchen areas with visual inspections for preventing potential risk of foodborne outbreaks in food service operations.
Most local health departments utilize visual, but not microbiological, methods when inspecting food service operations. To evaluate the marginal utility of microbial testing for minimizing potential risks of foodborne outbreaks in restaurants, swab samples were taken from handwashing sink faucets, freshly cleaned and sanitized food-contact surfaces, and from cooler or freezer door handles in 70 of 350 category-three (high-risk) food service operations in Toledo, Ohio. The swabs were inoculated onto different selective media, and standard procedures were used to identify pathogenic and nonpathogenic bacteria. Microbiological evaluations of the sampled food service operations were compared with visual inspection reports, using a numeric rating scale. Enteric bacteria (that may indicate fecal contamination) were found on food contact surfaces, on cooler or freezer door handles, and on handwashing sink faucets in 86, 57, and 53% of the food service operations, respectively. Approximately 27, 40, and 33% of the restaurants received visual ratings of very poor to poor, fair, and good to very good, respectively. In comparison, 10, 17, and 73% of the restaurants received microbiological rating scores of very poor to poor, fair, and good to very good, respectively. Restaurants with trained personnel received significantly higher visual rating scores than restaurants without trained personnel (P < 0.01). Although more restaurants received poor rating scores by visual inspection than by microbiological evaluation, the presence of fecal bacteria from different sites in more than 50% of the food service operations indicated that visual inspection alone might not be sufficient for minimizing potential risk for foodborne disease outbreaks. Therefore, we recommend periodic microbiological evaluation of high-risk food service operations, in addition to visual inspection, for minimizing the risk of foodborne disease outbreaks.
Colony Count, Microbial↗