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PubMed2002

Behavior change outcomes in an outpatient cardiac rehabilitation program.

OBJECTIVE: To evaluate the effectiveness of nutrition education within an outpatient cardiac rehabilitation program. DESIGN: Subjects were assigned, according to participation in cardiac rehabilitation programs in two community hospitals within an integrated healthcare system, to either a treatment (n=54), or a control group (n=50). SUBJECTS/SETTING: One hundred four men and women, age range 35 to 85 years, participating in a 6-week cardiac rehabilitation program. Most were men (80%) and overweight. The majority presented with the diagnosis of myocardial infarction followed by coronary artery bypass surgery or percutaneous transluminal coronary angiography procedure. INTERVENTION: Subjects in the control group received usual nonindividualized nutrition education from cardiac rehabilitation therapists. Subjects in the treatment group attended two group nutrition education classes and one individual diet counseling session, all led by the same dietitian. MAIN OUTCOME MEASURES: Changes in fat, saturated fat, cholesterol, and carbohydrate intake, and restaurant eating habits as assessed by the Diet Habit Survey; changes in cardiac diet self-efficacy; and changes in health-related quality of life. Statistical analyses performed Group-by-time analysis of variance with repeated measures, chi2 test. RESULTS: The treatment group had greater improvement in Restaurant and Recipes scores on the Diet Habit Survey (2.6 vs 1.0) and a greater cardiac diet self-efficacy mean score (4.3) compared with the control group (3.8), with the greatest change in items related to eating in restaurants, away from home, or when alone. From entry into the program to discharge, the cholesterol-saturated fat index decreased significantly in the control group (from 57 to 48), and in the treatment group (from 51 to 42). The percent of energy from carbohydrate increased significantly in the control group (from 51% to 55%) and in the treatment group (from 53% to 57%). There were no differences between groups over the 3 time periods (baseline, 6 weeks, and 3-month follow-up) (n=39 for control group and n=47 for treatment group for all 3 time periods). APPLICATIONS/CONCLUSIONS: Nutrition education within an outpatient cardiac rehabilitation program can improve dietary choices at restaurants and boost self confidence in the ability to adhere to a lipid-lowering diet.

Adult↗
PubMed2003

Time to eat: the relationship between the number of people eating and meal duration in three lunch settings.

We conducted an observational study of customers in three different types of lunch settings: a worksite cafeteria, a fast-food restaurant, and a moderately priced restaurant, and assessed the relationship between meal duration and the number of people eating at each table (group size). Results suggest a significant positive correlation between group size and meal duration, collapsing over eating settings. Analysis of variance yielded significant main effects of both eating setting and of group size, indicating that meal durations were longest in the moderately priced restaurant and shortest in the fast-food restaurant. An interaction between group size and eating setting indicates that the magnitude of the group size effect on meal duration differed in the different situations, with the effect of group size on duration being smallest, but still significant, in the fast-food setting compared with the other two settings.

Eating↗
PubMed2000

The pandemic of Salmonella enteritidis phage type 4 reaches Utah: a complex investigation confirms the need for continuing rigorous control measures.

In 1995, Salmonella Enteritidis (SE) cases in the state of Utah increased fivefold. Isolates were identified as phage type 4 (PT4). Risk factors and sources of infection were investigated in two case-control studies, a traceback of implicated foods, and environmental testing. Forty-three patients with sporadic infections and 86 controls were included in a case-control study of risk factors for infection. A follow-up case-control study of 25 case and 19 control restaurants patronized by case and control patients examined risks associated with restaurant practices. In the first case-control study, restaurant dining was associated with illness (P = 0.002). In the follow-up case-control study, case restaurants were likelier to use > 2000 eggs per week (P < 0.02), to pool eggs (P < 0.05), and to use eggs from cooperative 'A' (P < 0.009). Eggs implicated in separately investigated SE PT4 outbreaks were traced to cooperative 'A', and SE PT4 was cultured from one of the cooperative's five local farms. We conclude that SE PT4 transmitted by infected eggs from a single farm caused a fivefold increase in human infections in Utah.

Adult↗
PubMed2006

Measured concentrations of VOCs in several non-residential microenvironments in the United States.

Individuals spend about 25% of their time in non-residential indoor microenvironments. For some of these microenvironments, particularly stores and restaurants, exposures to volatile organic compounds (VOCs), have not been well characterized. In the Boston Exposure Assessment in Microenvironments (BEAM) study, sampling using scripted activities was conducted in stores, restaurants, and transportation in the summer of 2003 and winters of 2004 and 2005. A suite of VOCs including hydrocarbons, several chlorinated compounds, and aldehydes was analyzed. Nine store types were sampled using a composite design to enable a greater number of stores to be visited. Stores had higher concentrations of formaldehyde, toluene, ethylbenzene, xylenes, and styrene than other microenvironments, particularly in certain store types. Geometric mean formaldehyde levels were highest in the housewares stores, at 53 microg/m3 (95% CI = 43, 66). Geometric mean toluene levels were highest in multipurpose stores, at 76 microg/m3 (95% CI = 50, 118). The levels observed in stores were several times higherthan levels found in transportation microenvironments, and indicate strong indoor sources. In contrast, benzene did not have significantly higher levels in stores than typically found outdoors. Concentrations of formaldehyde and benzene, ethylbenzene, xylenes, and styrene were strongly influenced by the presence of smoking in the dining microenvironment. Chloroform levels were higher in restaurants than in other microenvironments, with a geometric mean of 1.1 microg/m3 (95% CI = 0.7, 1.8). The VOC concentrations found in stores and restaurants in this study are a potentially important source of exposure for sensitive individuals or people who work in these microenvironments.

Air Pollution, Indoor↗
PubMed2000

Dietary determinants of energy intake and weight regulation in healthy adults.

Until recently, the percentage of energy from dietary fat has been considered a primary determinant of body fatness. This review covers recent studies from our laboratory that challenge this notion. High and low fat diets matched for energy density, palatability and fiber resulted in similar mean voluntary energy intakes over 9 d; analysis of the individual foods in these diets showed that energy density and palatability were significant determinants of energy intake, independent of fat content. Path analysis further revealed that the influence of energy density on energy intake was in part direct, and in part indirect and mediated by palatability. In another study, dietary variety within food groups was shown to be an important predictor of body fatness, and the direction of the association depended on which food groups provided the variety, i.e., the variety of sweets, snacks, condiments, entrees and carbohydrates consumed was positively associated with body fatness, whereas the variety of vegetables was negatively associated. Last, a study of restaurant food and body fatness showed that the frequency of consumption of restaurant food was positively associated with body fatness, independent of education level, smoking status, alcohol intake and physical activity. Restaurant meals tend to be high in fat and low in fiber, and thus energy dense. Restaurants also typically serve a variety of palatable foods in large portions. The increasing variety of high energy foods available and the increasing proportion of household income spent on foods consumed away from home may help explain the U.S. national rising prevalence of obesity.

Adult↗
PubMed1989

Role of Norwalk virus in two foodborne outbreaks of gastroenteritis: definitive virus association.

Two separate food-associated outbreaks of gastroenteritis occurred among Erie County, New York residents in June 1986. In one outbreak, cases of illness were estimated to have occurred in 50% of the approximately 700 persons in 13 groups who ate at an out-of-county restaurant during a seven-day period, and, in the second outbreak, illness occurred in 26 (30%) of 87 persons who attended a graduation party held in a private home. Laboratory investigation included serology (blocking radioimmunoassay) to determine seroconversion to Norwalk virus and an enzyme immunoassay for detection of Norwalk virus antigen in stools, which the investigators have found to be more specific for Norwalk virus than serology. Seroconversion to Norwalk virus occurred in 11 (79%) of 14 restaurant-related cases and seven (100%) of seven graduation party cases. Seroconversion to Norwalk virus antigen was also found in four (40%) of 10 food handlers at the restaurant and in two (100%) of two food handlers at the graduation party. Antigen was detected in the stools of three (20%) of 15 restaurant-related cases and four (67%) of six graduation party cases. No stools for viral analyses were available for testing from food handlers. All seven of the patients with Norwalk virus-positive stools were also positive by seroconversion. Widespread availability of reagents for stool antigen detection would result in confirmation of more outbreaks due to Norwalk virus and in a more timely manner.

Disease Outbreaks↗
PubMed1999

Compliance with the New York City Smoke-Free Air Act.

This study's objective was to determine the level of compliance with the New York City Smoke-Free Air Act. Three data sources were used: (1) a population-based telephone survey of 251 New York City restaurant owners/managers; (2) independent inspections of the 251 surveyed restaurants; and (3) complaint records from the New York City Department of Health from April 1995 to March 1997. Ninety percent of restaurant owners/managers reported their indoor dining area was smoke-free in compliance with the law. Most New York City restaurants were able to comply with the smoke-free law with relative ease and little expense.

Chi-Square Distribution↗
PubMed1999

Breastfeeding in public places.

This study reports the results of a survey of restaurant and shopping center managers concerning breastfeeding in their facilities. Managers from 66 restaurants and 27 shopping centers were interviewed by telephone. One-third of the restaurant managers and 48% of the shopping center managers stated that a mother could breastfeed anywhere in their facility regardless of what other customers might say. The remaining managers would either discourage breastfeeding anywhere in their facility, suggest a mother move to a more secluded area if she wished to breastfeed, or were unsure how they would react. The variability in support for breastfeeding by managers of restaurants and shopping centers will continue to create uncertainty for mothers wishing to breastfeed in these public places.

Attitude to Health↗
PubMed2003

Evaluation informs coalition programming for environmental tobacco smoke reduction.

The objective for this formative evaluation was to establish baseline data for informing a community coalition's strategic planning in environmental tobacco smoke (ETS) risk reduction. The coalition had chosen 3 targeted settings for ETS risk reduction: restaurants, childcare facilities, and government buildings. The evaluation methodology involved telephone interviews (restaurants, n = 805; governmental buildings, n = 258) and mailed surveys (childcare facilities, n = 1,142). Data on county residents and businesses were used for comparison purposes and were analyzed from the Nebraska Social Climate Survey (2001; n = 558). Evaluation baseline findings showed that licensed childcare facilities were more ETS knowledgeable, less ETS tolerant, and more smoke-free than restaurants. Residents were more bothered by ETS than what restaurant proprietors perceived. The majority of governmental buildings were not smoke-free. Conclusions were that community health nurse evaluators can provide coalitions with formative evaluative data to inform strategic planning and increase the likelihood of effective program interventions for community impact on ETS.

Attitude to Health↗
PubMed2006

Food-service establishment wastewater characterization.

Food-service establishments that use on-site wastewater treatment systems are experiencing pretreatment system and/or drain field hydraulic and/or organic overloading. This study included characterization of four wastewater parameters (five-day biochemical oxygen demand [BOD5]; total suspended solids [TSS]; food, oil, and grease [FOG]; and flow) from 28 restaurants located in Texas during June, July, and August 2002. The field sampling methodology included taking a grab sample from each restaurant for 6 consecutive days at approximately the same time each day, followed by a 2-week break, and then sampling again for another 6 consecutive days, for a total of 12 samples per restaurant and 336 total observations. The analysis indicates higher organic (BOD5) and hydraulic values for restaurants than those typically found in the literature. The design values for this study for BOD5, TSS, FOG, and flow were 1523, 664, and 197 mg/L, and 96 L/day-seat respectively, which captured over 80% of the data collected.

Food Services↗
PubMedDate not supplied

The center-cut solution.

Timothy Firnstahl owns five successful restaurants in Seattle, but he recently came very close to owning none. In the early 1990s, he found himself, like so many restauranteurs, facing rising costs, inefficient management, and a recession. Confronting financial annihilation, Firnstahl had to act quickly: since he had no peripherals to trim, he cut off the head of his company. Remarkably, it worked. Firnstahl's problem was his new and innovative restaurant, Sharps Fresh Roasting. The heart of the Sharps concept was a unique long-roasting technique that made lean, inexpensive meats taste as juicy and delicious as fattier, expensive cuts. The process also lent itself to faster service and lower labor costs. But it wasn't working. Sharps wasn't breaking even, and his other restaurants couldn't make up the difference. He needed a solution fast. Firnstahl got his answer from Mikhail Gorbachev: slash the centralized command and liberate the company. In doing so, he would also transfer virtually all power and responsibility to his line managers. And after five months of intensive study and planning, he accomplished what he set out to do. He fired most of his corporate staff, empowered his restaurant managers with "100% Power and Responsibility," and, finally, undertook a massive promotion campaign. A year later, Sharps Fresh Roasting is the gold mine Firnstahl always believed it could be. He's done away with bureaucracy and turned business around in a down market. All this because his managers are managing themselves.

Decision Making, Organizational↗
PubMedDate not supplied

[Public food service in Milan city and Hinterland: GMP application (Part 1)].

Food service establishments are recognized as a critical sector concerning foodborne diseases occurrence, that is associated to contributing factors such as the anticipated preparation of meals that are often highly handled, and long-time distributed. A survey has been planned to evaluate the application of HACCP plan, in order to select a statistically representative sample of food services (restaurant, pizza-shop, bar, ..) in two Milan area' Public Health Units (PHU). During the inspections a proper check-list has been filled up in order to give a conformity evaluation about the global situation and about three specific sections: hygiene of food-handlers, procedures control, temperatures management. The food services have been found satisfactory in 9/106 and 5/54 cases in Milan City and in hinterland, respectively; among the two areas, highly significant differences have been revealed about temperatures management (68% and 28% unsatisfactory, respectively). In Milan City restaurants provided with HACCP plan scores are significantly different from unprovided restaurants scores (global and the three sections' evaluation); in Milan hinterland differences between provided and unprovided HACCP plan restaurants regard temperature management scores only. Useful suggestions to improve the quality of surveillance activity come from complex and heterogeneous findings shown in this study.

Case-Control Studies↗
PubMed2006

Recurrent critical violations of the food code in retail food service establishments.

Records of restaurant inspections by public health departments provide sequential "snapshots" of conditions in retail food service establishments that can be used to identify risk factors and evaluate the effectiveness of interventions. Data from a random 10 percent sample of restaurant inspection files from 31 counties in Oklahoma, including 4,044 inspections conducted during 1996-2000 in "medium-risk" and "high-risk" establishments, were analyzed to determine rates of critical violations and recurrent violations for different categories of establishments. Repeat violations accounted for about half of all violations. Establishments subjectively designated as high risk by health department personnel were in fact found to have higher violation rates than those described as medium-risk establishments. Outside Oklahoma County, regional chain restaurants were significantly more likely than other restaurants to have recurrent violations of critical items related to food-holding temperature, hygiene practices, sanitization, and hygiene facilities. Differences observed in violation rates among individual establishments were not primarily attributable to inconsistent enforcement by individual inspectors; rather, they appeared to be indicative of real differences in hygienic conditions and practices.

Food Inspection↗
PubMed2006

Fruit, vegetable, and fat intake among non-Hispanic black and non-Hispanic white adolescents: associations with home availability and food consumption settings.

OBJECTIVE: This study sought to explore home food availability and common settings of food consumption as correlates of fruit, vegetable, and fat intake among a sample of non-Hispanic black and non-Hispanic white adolescents. PARTICIPANTS AND DESIGN: Adolescents (n=144 black, 84 white) and their parents completed a cross-sectional survey in an urban adolescent health clinic. The adolescent survey included screening measures for fruit, vegetable, and fat intake and items on frequency of eating meals with family, while watching television, and at three types of restaurants. Parents provided information on home availability of foods. MAIN OUTCOMES: Correlates of fruit, vegetable, and fat consumption. STATISTICAL ANALYSIS: Spearman correlations for associations among variables, t tests for mean comparisons, and multiple stepwise regression conducted separately for black and white adolescents. RESULTS: In multiple regression, home availability was not significantly associated with fruit, vegetable, or fat intake except for fruit intake among white adolescents only. Use of non-fast-food restaurants was the strongest positive predictor of vegetable intake. For both black and white adolescents, fast-food and buffet restaurant use and eating while watching television were the strongest predictors of fat intake. CONCLUSIONS: Compared with restaurant use and eating while watching television, home availability had a relatively small impact on fruit, vegetable, and fat consumption for both black and white adolescents. Intervention programs on adolescent nutrition should target not just availability of healthful foods, but also ease of access, such as the preparation of fruits and vegetables so that they are flavorful and ready to eat.

Adolescent↗
PubMedDate not supplied

[Measurement of exposure to environmental tobacco smoke in education centers, health centers, transport facilities and leisure places].

OBJECTIVES: To describe levels of exposure to environmental tobacco smoke (ETS) in various public places in Barcelona (Spain). MATERIAL AND METHOD: Vapor-phase nicotine was measured with passive samplers containing a sodium bisulfate treated filter with a 37 mm diameter. The places sampled were primary and secondary schools, hospitals, primary care centers, train stations, subways, universities, airports, restaurants and discotheques. RESULTS: Primary and secondary schools and health centers had the lowest levels of ETS exposure, with mean concentrations of less than 1 microg/m3. The mean values found in transport and universities were 2.16 microg/m3 in train stations, 3.30 microg/m3 in subways, 4.30 microg/m3 in airports and 4.97 microg/m3 in universities. The highest concentrations were found in restaurants and discotheques, with mean values of 12.36 microg/m3 in restaurants and 130.65 microg/m3 in discotheques. All samples taken from primary and secondary schools, airports, subways, restaurants and discotheques contained ETS. Likewise, 90% of the samples taken from train stations and 96% of those from universities contained ETS. Seventy-nine percent of the samples from hospitals and 58% of those from primary care centers contained ETS. CONCLUSIONS: The results confirm that passive smoking is an important public health problem in Spain and that greater efforts are needed to enforce smoke-free policies in public spaces and workplaces.

Cross-Sectional Studies↗
PubMed2006

Carbonyl emissions from commercial cooking sources in Hong Kong.

Cooking fumes are an important carbonyl emission source, especially in a highly urbanized city, such as Hong Kong. Cooking exhaust from 15 commercial kitchens of a variety of cooking styles was sampled and analyzed for a suite of 13 carbonyl compounds. Carbonyl compositions were varied among the different cooking styles. Formaldehyde was generally the most abundant carbonyl, and its contribution to the total carbonyl amount on a molar basis ranged from 12 to 60%. Acrolein was also found to be an abundant carbonyl in the cooking exhaust. The highest contribution by acrolein to the total carbonyls was found to be 30% in the exhaust of a western-style steak restaurant. Long-chain saturated carbonyls, that is, heptanal, octanal, and nonanal, accounted for a significant fraction (> 40%) of the total carbonyls in kitchens that always used heated cooking oils. Two dicarbonyls, glyoxal and methylglyoxal, had a various presence in the cooking emissions, ranging from negligible to 10%. The presence of benzaldehyde and tolualdehyde was mostly negligible in the sampled kitchen exhaust. Annual emission rates of both individual carbonyls and total carbonyls were estimated for various types of commercial kitchens. Local-style fast-food shops contributed the highest total carbonyl emissions per year mainly because of the large number of this kind of restaurant in Hong Kong. The citywide annual emission rates of the three most toxic carbonyls, formaldehyde, acetaldehyde, and acrolein, were estimated assuming that the limited number of sampled restaurants were representative of the average restaurants. Such estimates of carbonyl emission rates were comparable to the estimated carbonyl emissions from vehicular sources, suggesting the importance of commercial cooking as a source for carbonyls in Hong Kong.

Air Pollutants, Occupational↗
PubMed1998

Prospective investigation of cryptic outbreaks of Salmonella agona salmonellosis.

The number of Salmonella agona isolates reported annually in Texas from 1992 through 1994 ranged from 14 to 21. An increase in incidence of S. agona infections was noted in the fall of 1995. Pulsed-field gel electrophoresis (PFGE) analysis identified prospectively two possible cryptic outbreaks caused by an indistinguishable strain which was isolated from 18 of 59 patients who were culture positive from March through December 1995. These 18 patients had onset of illness from 20 May through 3 October 1995. Eight individuals resided in the Austin area, eight resided in San Antonio, and two resided in Houston; none had attended a common social gathering or owned common pets. Six patients in San Antonio and one patient from Houston recalled eating food items from the same Mexican food restaurant in San Antonio. S. agona organisms with the same PFGE profile were isolated from machacado, an air-dried, raw beef product prepared at the restaurant. The machacado had been shredded in a kitchen blender which was the probable source for cross-contamination of other food items. Five patients in Austin reported eating at a popular Mexican food restaurant in Austin. Improperly prepared machacado also may have been served at the Austin restaurant; however, sufficient quantities of machacado were not available for analysis. PFGE was essential in determining whether the cases constituted outbreaks and was invaluable in guiding the epidemiological investigation.

Demography↗
PubMed1992

Creating partnership with the food industry in the Stockholm cancer prevention program.

To facilitate the supply of healthful foods in institutional kitchens and restaurants, the Stockholm Cancer Prevention Program (SCPP) produced a cookbook in collaboration with the food industry and the SCPP. Fifty different organizations participated in this work. The development of the cookbook was made in several steps and started with a recipe contest to engage chefs and employees in restaurants and institutional kitchens. Criteria for the recipes were that they should present low-fat/high-fiber meals. Complementary recipes were received from the food industry. All recipes were tested in 20 restaurants and institutional kitchens and 11,000 lunch guests assessed the palatability of the dishes. The cookbook was presented in conjunction with a food fair in 1989 and has until now been sold in about 4,000 copies. Production of a cookbook can thus be a focal point for involving food industry, restaurants and institutional kitchens in a community intervention program aiming at a change of dietary habits.

Books↗