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The fat content of meals provided by catering establishments.

A study of the food input and food waste from 38 catering establishments varying from hospital and school meals to hotels and commercial restaurants has shown that on average 46 per cent of the dietary energy of the food consumed was derived from fat. Moreover, a strong positive correlation (P less than 0.001) was found between the percentage energy derived from fat, and the total energy obtained from the food consumed. A similar pattern is shown when the results are broken down according to the category of catering establishments. Meals provided by hotels, restaurants and public houses have the highest fat content (60 per cent of energy) and the highest total energy consumed (6.8 MJ per person per meal), whereas meals served by welfare establishments have the lowest fat content and lowest total energy per meal.

Dietary Fats↗

The role of location of food consumption in the prevention of travelers' diarrhea in Mexico.

The location of food consumption was recorded daily for 3 wk by 130 United States summer students newly arrived in Guadalajara, Jalisco, Mexico, as part of an assessment of bismuth subsalicylate vs. placebo in the irevention of travelers' diarrhea. Eating at locations other than homes and apartments (P < 0.025), and specifically at restaurants, was associated with an increased occurrence of diarrhea. Less eating at restaurants (P < 0.005), street vendors (P < 0.005), and school cafeterias (P < 0.01) was associated with reduced occurrence of travelers' diarrhea, even among persons taking bismuth subsalicylate as a preventive measure.

Bismuth↗

Outbreak of Shigella flexneri linked to salad prepared at a central commissary in Michigan.

In August 1992, the Michigan Department of Public Health was notified of a cluster of persons with Shigella flexneri infections, all of whom had eaten at different outlets of a single restaurant chain. The chain prepared many foods at a central kitchen. A matched case-control study to determine risk factors for illness among patrons of the restaurant chain was undertaken. An inspection of the commissary and a review of commissary inspection and employee records were conducted. Of the 46 patients identified, 44 had eaten tossed salad versus 33 of the 71 controls (matched odds ratio = 56.9; 95 percent confidence interval 5.0, 648.1). Improper salad preparation techniques were used, and the salad preparation area had not been inspected in several years. Some salad preparers had been ill shortly before the outbreak but continued to work. The greater use of central kitchens could lead to larger outbreaks of illness related to improper food handling. Raw vegetables are a potential vehicle for transmission of shigellosis. Coordination of all agencies responsible for inspecting commissaries should be assured. Assuring restriction of ill food handlers will require management to take an active role in identification of ill employees and in the development of incentives to report illness.

Adolescent↗

A multistate outbreak of Escherichia coli O157:H7-associated bloody diarrhea and hemolytic uremic syndrome from hamburgers. The Washington experience.

OBJECTIVE: To determine the source of and describe a large outbreak of Escherichia coli O157:H7 infections in Washington State. DESIGN: Case-control study; environmental investigation; provider-based surveillance for E coli O157:H7 infections. SETTING: Chain of fast-food restaurants, hospitals, physician offices, local laboratories, and local health departments. PARTICIPANTS: Patients with diarrhea and neighborhood controls. A case was defined as diarrhea with culture-confirmed E coli O157:H7 infection or postdiarrheal hemolytic uremic syndrome (HUS) occurring from December 1, 1992, through February 28, 1993, in a Washington State resident. Controls were age- and neighborhood-matched friends of the first 16 case patients. INTERVENTIONS: Announcement to the public; recall of implicated hamburger lots. MAIN OUTCOME MEASURE: Abatement of outbreak due to E coli O157:H7. RESULTS: Infection was associated with eating at a fast-food chain (chain A) in the 10 days before symptoms began. Twelve (75%) of 16 case patients but no controls had eaten at chain A (matched odds ratio undefined; lower 95% confidence interval, 3.5; P < .001). In total, 501 cases were reported, including 151 hospitalizations (31%), 45 cases of HUS (9%), and three deaths. Forty-eight patients (10%) had secondary infections. Of the remaining 453 patients (90%), 398 (86%) reported eating at a Washington chain A restaurant; 92% of them reported eating a regular hamburger. The pulsed-field gel electrophoresis pattern of the E coli O157:H7 strains isolated from all regular hamburger lots of a single production date shipped to Washington was identical to that of the strains isolated from patients. Ten (63%) of 16 regular hamburgers cooked according to chain A policy had internal temperatures below 60 degrees C. Public health action removed more than 250,000 potentially contaminated hamburgers, preventing an estimated 800 cases. CONCLUSIONS: This E coli O157:H7 outbreak, the largest reported, resulted from errors in meat processing and cooking. Public health surveillance through state-mandated reporting of E coli O157:H7 infection as is carried out in Washington State was critical for prompt outbreak recognition and control. Measures should be developed to reduce meat contamination. Consumers and food service workers should be educated about cooking hamburger meat thoroughly.

Adolescent↗

A cluster of Escherichia coli O157:H7 infections with the hemolytic-uremic syndrome and death in California. A mandate for improved surveillance.

In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic syndrome had been reported in San Diego County, California. A total of 34 persons had bloody diarrhea, the hemolytic-uremic syndrome, or E coli O157:H7 organisms isolated from stool during the period November 15, 1992, through January 31, 1993. Organisms of E coli O157:H7 identified from 6 persons were indistinguishable from those of the Washington outbreak strain. Illness was associated with eating at chain A restaurants in San Diego (odds ratio, 13; 95% confidence interval, 1.7, 99) and with eating regular-sized hamburgers (odds ratio, undefined; lower-limit 95% confidence interval, 1.3). Improved surveillance by mandating laboratory- and physician-based reporting of cases of E coli O157:H7 infection and the hemolytic-uremic syndrome might have alerted health officials to this outbreak sooner, which could have resulted in earlier investigation and the institution of measures to prevent more cases.

Adolescent↗

Histamine poisoning associated with eating tuna burgers.

CONTEXT: Histamine poisoning occurs when persons ingest fish in which bacteria have converted histidine to histamine, a process that usually can be controlled by storage at low temperatures. From 1994 to 1997, North Carolina averaged 2 cases annually; however, from July 1998 to February 1999, a total of 22 cases of histamine fish poisoning were reported. OBJECTIVES: To examine the increase in histamine case reports, identify risk factors for poisoning, and develop recommendations for prevention. DESIGN AND SETTING: Case series evaluated in North Carolina from July 1998 to February 1999. SUBJECTS: Reported case-patients with 2 of the following symptoms within 2 hours of eating tuna: rash, facial flushing, vomiting, diarrhea, dyspnea, a tight feeling in the throat, headache, or a metallic or peppery taste in the mouth. RESULTS: Twenty cases occurred during 5 outbreaks, and there were 2 single occurrences. Of the 22 persons affected, 19 (86%) sought emergency medical care. All case-patients ate tuna: 18 ate tuna burgers, 2 ate salad containing tuna, and 2 ate filets. Tuna samples (available from 3 outbreaks) had histamine levels above the Food and Drug Administration regulatory level of 50 ppm (levels were between 213 and 3245 ppm). In 19 cases, the tuna used to prepare burgers or salads was frozen and thawed more than once before serving. Violations of recommended temperature controls were identified in 2 of the 5 restaurants, accounting for 14 (64%) cases. CONCLUSIONS: Tuna burgers, a relatively new menu item in restaurants, were associated with an increase in histamine poisoning cases in North Carolina. Tuna ground for burgers can be susceptible to both temperature fluctuations and bacterial contamination.

Animals↗

Secondhand tobacco smoke in public places in Latin America, 2002-2003.

CONTEXT: The success of measures to restrict smoking in indoor environments and the intensity of enforcement vary among countries around the world. In 2001, the Pan American Health Organization (PAHO) launched the Smoke-Free Americas Initiative to build capacity to achieve smoke-free environments in Latin America and the Caribbean. OBJECTIVE: To assess secondhand smoke concentrations in public places in the capital cities of Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru, and Uruguay in conjunction with the Smoke-Free Americas Initiative. DESIGN AND SETTING: Multicountry assessment of vapor-phase nicotine concentrations using a common protocol in all 7 Latin American countries. A total of 633 sampling devices were placed for 7 to 14 days in 1 hospital, 2 secondary schools, 1 city government building, 1 airport (2 in Argentina), and restaurants and bars in each country. MAIN OUTCOME MEASURE: Concentrations of airborne nicotine. RESULTS: Airborne nicotine was detected in most (94%) of the locations surveyed. By country, Argentina and Uruguay had the highest median concentrations in most environments (eg, in hospitals: 1.33 [interquartile range [IQR], 0.51-3.12] microg/m3 and 0.8 [IQR, 0.30-1.69] microg/m3, respectively). Overall, bars and restaurants had the highest median concentrations (3.65 [IQR, 1.55-5.12] microg/m3 and 1.24 [IQR, 0.41-2.48] microg/m3, respectively). Nicotine concentrations were also found in a number of key, sentinel buildings, including 95% (155/163) of hospital samples (in the physicians' and nurses' stations the median was 0.27 [IQR, 0.02-1.94] microg/m3), schools, government buildings, and/or airports in most countries. CONCLUSIONS: The finding of airborne nicotine in critical locations in Latin America provides a basis for enforcing smoke-free initiatives and for strengthening the protection of the public from unwanted exposure to secondhand smoke.

Argentina↗

Occupational injuries among adolescents in Washington State, 1988-1991.

BACKGROUND: To characterize work-related injuries and illnesses in minors. METHODS: We analyzed Washington State workers' compensation claims from 1988 through 1991. RESULTS: There were 17,800 claims among adolescents from age 11 through 17 years accepted in the 4-year period, including three occupational fatalities, 22 amputations, and 464 fractures; 89% of all injuries occurred among the 16- and 17-year-olds. Claims were most frequent in restaurants, food stores, service industry, other retail and wholesale trade, and agriculture. Washington State census data were used for denominator in calculating injury rates for adolescents and adults. The crude injury rate for 16- and 17-year-olds employed at the time of the census was similar to that seen among adults (9.0 vs 10.4 per 100 workers), despite that minors work fewer hours per year. The rate among boys was almost twice that seen among girls (11.7 vs. 6.4 per 100 workers). Highest rates, per 100 workers, were in public administration (27.0), construction (21.1), agriculture (11.4), and restaurants (11.0). Using census data for those working anytime over the course of the year and adjusted for the number of hours worked, the injury rate for 16- and 17-year-olds was 19.4/100 full time equivalents compared with 10.6 of 100 full-time equivalents for adults. Most injuries were lacerations, sprains and strains, contusions, and burns. CONCLUSIONS: Public health policy and injury prevention strategies for working adolescents should be developed and implemented.

Accidents, Occupational↗

Gender differences in meal patterns: role of self-caught fish and wild game in meat and fish diets.

The hypothesis that there are gender differences in consumption patterns of self-caught fish and wild game in the meat and fish diet was examined for 415 people attending the Palmetto Sportsmen's Classic in Columbia, South Carolina. Women were less likely to eat most types of wild fish and game than were men, although there were no gender differences in the percentage eating beef, chicken, pork, and restaurant and store-bought fish. Similarly, women consumed significantly fewer meals of wild-caught fish and game than did men, although the number of meals of most store-bought foods did not differ. Both men and women who ate more meals of fish ate a higher percentage of wild-caught fish than either store-bought or restaurant fish. People with low number of fish and meat meals ate mainly fish; people eating over 30 meals of meat and fish a month ate mainly meat. Only about 9% of those interviewed said that they changed their fish consumption patterns when they, or their spouse, were pregnant. These gender-specific data on protein consumption can be used for exposure assessment and risk management decisions regarding consumption advisories for wild-caught fish and game.

Adolescent↗

The significance of excursions above the ADI. Case study: monosodium glutamate.

Monosodium glutamate (MSG) has been allocated an "ADI not specified" by the JECFA, which indicates that no toxicological concerns arise associated with its use as a food additive in accordance with good manufacturing practice (GMP) and for that reason it is not necessary to allocate a numerical ADI. The question in this case, then, is not whether excursions above a numerical ADI might occur but whether high peak intakes might arise which could invalidate the assumption of absence of hazard. Two major issues have arisen in relation to high intakes of MSG: (1) What is the significance of neural damage (focal necrosis in the hypothalamus) seen following high parenteral or intragastric doses of MSG to neonatal animals and is this a particular risk for children? (2) What is the role of MSG in "Chinese Restaurant Syndrome" (flushing, tightness of the chest, difficulty in breathing, etc.) following consumption of Chinese foods? In relation to the first issue, human studies have been crucial in resolving the question. The threshold blood levels associated with neuronal damage in the mouse (most sensitive species) are 100-130 mumol/dl in neonates rising to > 630 mumol/dl in adult animals. In humans, plasma levels of this magnitude have not been recorded even after bolus doses of 150 mg/kg body wt (ca. 10 g for an adult). Additionally, studies in infants have confirmed that the human baby can metabolize glutamate as effectively as adults. It is concluded that blood levels of glutamate + aspartate do not rise significantly even after abuse doses and babies are no more at risk than adults. Intake levels associated with the use of MSG as a food additive and natural levels of glutamic acid in foods therefore do not raise toxicological concerns even at high peak levels of intake. It is not envisaged that use of MSG according to GMP requires the allocation of a numerical ADI. With regard to the second issue, controlled double-blind crossover studies have failed to establish a relationship between Chinese Restaurant Syndrome and ingestion of MSG, even in individuals reportedly sensitive to Chinese meals, and MSG did not provoke bronchoconstriction in asthmatics. Thus, high usage of MSG in ethnic cuisines does not represent a situation in which intakes might achieve unsafe levels, even among individuals claiming idiosyncratic intolerance of such foods. In the light of the toxicological studies, the human metabolic studies in neonates and adults, and the physiological and nutritional role of glutamic acid and the fact that food additive use does not markedly increase the total dietary burden, no foreseeable circumstances arise in which intakes would be such as to invalidate the appropriateness of allocating an ADI not specified to MSG.

Adult↗

An outbreak of group A food-borne streptococcal pharyngitis.

A food-borne outbreak of pharyngitis from group A streptococcus developed in people attending wedding banquets in the same restaurant on July 5-8, 1986. Of the 300 people interviewed, 179 reported illness; pharyngeal swabs were taken from 115 ill people; from 63 (53%) of them group A streptococci, belonging to serotype T28, M28, were isolated. Statistical analysis performed using chi-square and Cochran's test showed that a prawn hors-d'oeuvre served on July 5 and squills or/and custard cake served on July 7 could have been a possible source of infection. Six people on the staff, 5 of whom belonged to the family of the restaurant manager, and the manager's three young daughters were colonized by the same group A serotype. A possible previous diffusion of the strain among the staff followed by contamination of the food was suspected.

Acute Disease↗

The histamine content of oriental foods.

Several of the symptoms of scombroid poisoning (i.e. histamine toxicity) resemble those observed in people suffering from Chinese restaurant syndrome. Therefore, the histamine content of representative Chinese cuisine, which included 31 common dishes, 12 condiments and 12 basic ingredients from several sources, was measured using a sensitive and specific radioenzymatic assay. A further enzymatic procedure involving diamine oxidase was used to verify that the substance measured was histamine. A total of 184 assays were performed on 57 samples in the study. High levels of histamine were found in the cheeses, which were used as positive controls (863.6 micrograms histamine/g blue cheese and 107.4 micrograms histamine/g Parmesan cheese), and in some common condiments, including tamari (2392.2 micrograms histamine/g sample) and one brand of soy sauce (220.4 micrograms histamine/g sample). The histamine content of four condiments and three common dishes was over 10 micrograms histamine/g sample, while four condiments and 16 common dishes contained less than 1 microgram histamine/g sample. Calculations involving representative amounts of food that can be consumed at a typical oriental meal suggest that, in some cases, histamine intake may approach toxic levels. The results are discussed with regard to the possible role of histamine in reactions associated with restaurant meals.

Animals↗

Acculturation, drinking and social settings among U.S. Hispanics.

This paper reports survey data on drinking in different social settings and the acculturation of Hispanics to U.S. society. Respondents comprise a household probability sample of U.S. Hispanics. The acculturation scale resulted from the factor analysis of respondents' answer to questions on daily use and ability to speak, read and write English and Spanish; preference for media (books, radio TV, music) in English or in Spanish; ethnicity of people they interact with in their church, parties and neighborhood now and when growing up, as well as questions about values thought to be characteristic of the Hispanic way of life. Seven different social settings are considered: when having an evening meal at a restaurant; when having lunch at a restaurant; when attending clubs or organizational meetings; in bars, taverns or cocktail lounges; at parties; during evenings at home; and when friends are visiting. Analysis of these data confirm the hypothesis that Hispanics who are more acculturated go more frequently and drink more frequently than less acculturated Hispanics in a number of social settings. The effect of acculturation is independent of income and work status.

Acculturation↗

Psychoactive mushroom use in Koh Samui and Koh Pha-Ngan, Thailand.

This paper presents the results of recent ethnomycological exploration in southern Thailand. Field observations, interviews and collection of fungi specimens were carried out primarily on two islands, Koh Samui and Koh Pha-ngan, situated in the western region of the Gulf of Siam. Some fieldwork was also conducted in the northern Thai province of Chiang Dao and in the southern Thai province of Surat Thani. During five separate excursions (1989-90), observations were made of occurrence, harvesting, use, and marketing of psychoactive fungi by local Thai natives (males and females, adults and children), foreign tourists, and German immigrants. The first records of psychoactive Psilocybe subcubensis and Copelandia dung fungi in Thailand are presented in this paper. These fungi exhibited intense bluing reactions when handled, indicating the presence of psilocybin and/or psilocin. Seven collections of Psilocybe cubensis (Earle) Singer and/or Psilocybe subcubensis Guzman and four collections of Copelandia sp. were harvested and sun-dried for herbarium deposit. These fungi are cultivated or occur spontaneously, often appearing in the decomposed manure of domesticated water buffalo (Bubalus bubalis) and at least three different species of cattle (Bos indicus, B. guarus, and B. sundaicus). The psychoactive fungi are cultivated in clandestine plots, both indoors and outdoors, in the uplands and villages on Koh Samui by both Thai natives and some foreigners. The sale of psychoactive fungi directly to tourists and to resort restaurants for use in edible food items such as omelettes and soups is discussed in detail. The preparation and sale of mushroom omelettes adulterated with artificial hallucinogens in some restaurants is also discussed. In addition, the marketing of items such as hand painted T-shirts, post cards, and posters bearing mushroom related motifs in Thailand is described.

Animals↗

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence.

As part of a transcultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3/1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5/1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6/1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28/1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people greater than or equal to 60 years of age in all three areas investigated, ranging from 0 (men) to 1.3/1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02/1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.

Adolescent↗

Injuries due to deliberate violence in areas of Argentina. I. The extent of violence. Copenhagen Study Group.

As part of a transcultural investigation of violent behaviour in Argentina and Denmark an analysis was made of the incidents involving deliberate violence as registered in the emergency wards of Hospital Fernandez and Hospital Pinero in Capital Federal Buenos Aires over a period of 13 and 17 months, respectively. In the two emergency wards a total of 281 victims of deliberate violence were observed corresponding to a rate of approximately 0.2/1000 per year in a mainly middle income area of the metropolis Buenos Aires, the catchment region of Hospital Fernandez, and 0.6/1000 per year in a mainly low income area of Buenos Aires, the catchment region of Hospital Pinero. Men aged 20-24 years and 40-49 years were found to be the most frequent victims of deliberate violence, 13% and 11%, respectively. Elderly women greater than or equal to 60 years of age were rarely found to be victims of deliberate violence (2%). Skilled and unskilled male workers were over-represented as victims of violence. Sixty-four percent of the victims were men and 29% women, 6% were boys and 0.7% girls less than or equal to 14 years of age. Twenty-one percent of the male victims and 5% of the female victims were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for only 7% of the male victims, while 55% of male victims and 34% of female victims had been injured in the street, most often by non-acquainted men. Fifty-eight percent of the female victims had been subject to deliberate violence at home, in the majority of the cases beaten by their spouse. Twelve percent of the male victims and 8% of the female victims were estimated to be under the influence of drugs. The incidence of deliberate violence seems to be lower in Argentina than in Denmark. However, serious lesions appear to be considerably more frequent in male Argentinian victims compared to male Danish victims, maybe because the practice of seeking medical assistance is different in the two countries. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors. Influence of alcohol does not appear to play a role that is comparable to the situation observed in Denmark. A considerably larger percentage of victims in Argentina than in Denmark had been injured in the street.

Adult↗

Injuries due to deliberate violence in areas of Denmark. IV. Alcohol intoxication in victims of violence. The Copenhagen Study Group.

A material of 1316 victims of deliberate violence was collected prospectively during a one year period in three Danish emergency wards covering a provincial/rural area and two metropolitan areas. The frequency of alcohol intoxication was determined. Forty-one percent of the patients were intoxicated. The highest frequency was found in male victims, in the provincial/rural area, in restaurants or their vicinity, in the age group 35-49, during evenings and nights and in May. It is difficult to indicate specific preventive measures. However, a more restrictive attitude is suggested with regard to serving alcohol to intoxicated persons in restaurants.

Alcoholic Intoxication↗

Dry-thermophilic anaerobic digestion of organic fraction of the municipal solid waste: focusing on the inoculum sources.

The effect of inoculum source on anaerobic thermophilic digestion of separately collected organic fraction of municipal solid wastes (SC_OFMSW) has been studied. Performance of laboratory scale reactors (V: 1.1 L) were evaluated using six different inoculums sources: (1) corn silage (CS); (2) restaurant waste digested mixed with rice hulls (RH_OFMSW); (3) cattle excrement (CATTLE); (4) swine excrement (SWINE); (5) digested sludge (SLUDGE); and (6) SWINE mixed with SLUDGE (1:1) (SWINE/SLUDGE). The SC_OFMSW was separately and collected from university restaurant. The selected conditions were: 25% of inoculum, 30% of total solid and 55 degrees C of temperature, optimum in the thermophilic range. The six inoculum sources showed an initial start-up phase in the range between 2 and 4 days and the initial methane generation began over 10 days operational process. Results indicated that SLUDGE is the best inoculum source for anaerobic thermophilic digestion of the treatment of organic fraction of municipal solid waste at dry conditions (30%TS). Over 60 days operating period, it was confirmed that SLUDGE reactor can achieve 44.0%COD removal efficiency and 43.0%VS removal. In stabilization phase, SLUDGE reactor showed higher volumetric biogas generated of 78.9 mL/day (or 35.6 mLCH(4)/day) reaching a methane yield of 0.53 LCH(4)/gVS. Also, SWINE/SLUDGE and SWINE were good inoculums at these experimental conditions.

Anaerobiosis↗