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PubMed1995

Bridge to the future: nontraditional clinical settings, concepts and issues.

Healthcare restructuring in the wake of healthcare reform places greater emphasis on primary healthcare. Clinical education in acute care settings and existing community health agencies are not compatible with teaching basic concepts, principles and skills fundamental to nursing. Problems of clients in acute care settings are too complex and clients in the community are often too dispersed for necessary faculty support and supervision of beginning nursing students. Nontraditional learning settings offer the baccalaureate student the opportunity to practice fundamental skills of care and address professional skills of negotiation, assertiveness, organization, collaboration and leadership. An overview of faculty designed clinical learning experiences in nontraditional sites such as McDonald's restaurants, inner city churches, YWCA's, the campus community and homes are presented. The legal, ethical and academic issues associated with nontraditional learning settings are discussed in relation to individual empowerment, decision making and evaluation. Implications for the future address the role of the students and faculty as they interact with the community in which they live and practice.

Community Health Nursing↗
PubMed2000

Continuous source outbreak of campylobacteriosis traced to chicken.

Poultry is a source of human campylobacteriosis, but a large continuous source outbreak, heretofore, has not been attributed to both a single source of poultry and single serotype of Campylobacter. Here we report an outbreak of C. jejuni affecting 6 catering college trainees and 13 patrons of a restaurant in southern England. An epidemiological investigation successfully tracked the outbreak source to the farm of origin. Frequency of occurrence of campylobacters and outbreak serotype distribution were determined in index cases, the local population, and local chicken suppliers. The source farm was investigated and the effect of interventions assessed. A single outbreak serotype of C. jejuni was isolated from trainee chefs, patrons, and chicken supplied to the college by Wholesaler A. The Campylobacter isolation rate for Wholesaler A was 89% (98% outbreak serotype), compared to 40% for non-Wholesaler A (10% outbreak serotype). The isolation rate for 14 months averaged 85% (99% outbreak serotype) in chickens grown on two farms (X and Y) supplying Wholesaler A, contributing approximately 40% to all local cases. In the research reported here, a specific strain and hygiene practice were found to be important for understanding transmission of Campylobacter from poultry to humans in this outbreak.

Adolescent↗
PubMed2001

Populations of Vibrio parahaemolyticus in retail oysters from Florida using two methods.

Vibrio parahaemolyticus is a naturally occurring estuarine bacterium that is often associated with gastroenteritis in humans following consumption of raw molluscan shellfish. A number of studies have investigated the environmental distribution of V. parahaemolyticus, but little is known about the levels of this organism during distribution of oysters or at the point of consumption. Duplicate samples of shellstock oysters were collected monthly (September 1997 to May 1998) from the same four restaurants and three wholesale seafood markets in the Gainesville, Fla. area and analyzed for total V. parahaemolyticus densities using two methods: a standard MPN method (BAM-MPN) and a new direct plating procedure (direct-VPAP). Both methods employed an alkaline phosphatase-labeled DNA probe (VPAP) targeting the species-specific thermolabile hemolysin (tlh) gene to confirm suspect colonies as V. parahaemolyticus. The highest monthly geometric mean V. parahaemolyticus density was observed in October of 1997 (approximately 3,000/g) with similarly high values during September and November of 1997. From December 1997 to May 1998 mean densities were generally less than 100/g, falling to approximately 10/g in February and March. A strong correlation (r = 0.78) between the direct-VPAP and BAM-MPN methods for determining V. parahaemolyticus densities in market-level oysters was observed. The direct-VPAP method was more rapid and precise while the BAM-MPN was more sensitive and may better recover stressed cells. The utilization of the VPAP probe for identification of V. parahaemolyticus sharply reduced the labor for either method compared to biochemical identification techniques used in earlier V. parahaemolyticus surveys.

Animals↗
PubMed2002

Vibrio vulnificus and Vibrio parahaemolyticus in U.S. retail shell oysters: a national survey from June 1998 to July 1999.

From June 1998 to July 1999, 370 lots of oysters in the shell were sampled at 275 different establishments (71%, restaurants or oyster bars; 27%, retail seafood markets: and 2%, wholesale seafood markets) in coastal and inland markets throughout the United States. The oysters were harvested from the Gulf (49%). Pacific (14%), Mid-Atlantic (18%), and North Atlantic (11%) Coasts of the United States and from Canada (8%). Densities of Vibrio vulnificus and Vibrio parahaemolyticus were determined using a modification of the most probable number (MPN) techniques described in the Food and Drug Administration's Bacteriological Analytical Manual. DNA probes and enzyme immunoassay were used to identify suspect isolates and to determine the presence of the thermostable direct hemolysin gene associated with pathogenicity of V. parahaemolyticus. Densities of both V. vulnifcus and V. parahaemolyticus in market oysters from all harvest regions followed a seasonal distribution, with highest densities in the summer. Highest densities of both organisms were observed in oysters harvested from the Gulf Coast, where densities often exceeded 10,000 MPN/g. The majority (78%) of lots harvested in the North Atlantic, Pacific, and Canadian Coasts had V. vulnificus densities below the detectable level of 0.2 MPN/g; none exceeded 100 MPN/g. V. parahaemolyticus densities were greater than those of V. vulnificus in lots from these same areas, with some lots exceeding 1,000 MPN/g for V. parahaemolyticus. Some lots from the Mid-Atlantic states exceeded 10,000 MPN/g for both V. vulnificus and V. parahaemolyicus. Overall, there was a significant correlation between V. vulificus and V. parahaemolyticus densities (r = 0.72, n = 202, P < 0.0001), but neither density correlated with salinity. Storage time significantly affected the V. vulnificus (10% decrease per day) and V. parahaemolyticus (7% decrease per day) densities in market oysters. The thermostable direct hemolysin gene associated with V parahaemolyticus virulence was detected in 9 of 3,429 (0.3%) V. parahaemolyticus cultures and in 8 of 198 (4.0%) lots of oysters. These data can be used to estimate the exposure of raw oyster consumers to V. vulnificus and V. parahaemolyticus.

Animals↗
PubMed2004

Occurrence of Escherichia coli, noroviruses, and F-specific coliphages in fresh market-ready produce.

Forty samples of fresh produce collected from retail food establishments were examined to determine the occurrence of Escherichia coli, F-specific coliphages, and noroviruses. An additional six samples were collected from a restaurant undergoing investigation for a norovirus outbreak. Nineteen (48%) of the retail samples and all outbreak samples were preprocessed (cut, shredded, chopped, or peeled) at or before the point of purchase. Reverse transcription-PCR, with the use of primers JV 12 and JV 13, failed to detect norovirus RNA in any of the samples. All six outbreak samples and 13 (33%) retail samples were positive for F-specific coliphages (odds ratio undefined, P = 0.003). Processed retail samples appeared more likely to contain F-specific coliphages than unprocessed samples (odds ratio 3.8; 95% confidence interval 0.8 to 20.0). Only two (5.0%) retail samples were positive for E. coli; outbreak samples were not tested for E. coli. The results of this preliminary survey suggest that F-specific coliphages could be useful conservative indicators of fecal contamination of produce and its associated virological risks. Large-scale surveys should be conducted to confirm these findings.

Coliphages↗
PubMed2005

Beliefs about meals eaten outside the home as sources of gastrointestinal illness.

In a 2002 telephone survey of 16,435 randomly selected U.S. residents, respondents answered several questions about their beliefs concerning sources of gastrointestinal illness. Of those who had experienced vomiting or diarrhea in the month before their telephone interview, 22% believed the source of their gastrointestinal illness was a meal eaten outside the home. I11 respondents who had diarrhea but not vomiting and who did not miss work because of their illness were more likely to believe the illness resulted from a specific outside meal. I11 respondents attributed their illness to a specific outside meal for several reasons, including symptom timing (43%) and illness of their meal companions (6%). Eight percent of ill respondents reported their illness to a health department or the restaurant suspected of causing the illness. Those with vomiting and those who missed work or activities because of their illness were more likely to report their illness. Most respondents (54%) who attributed their illness to a specific outside meal said their illness symptoms began within a short time (5 h) of eating that meal. The foodborne illnesses for which this is a likely time frame typically are associated with vomiting, but respondents with vomiting did not report a shorter symptom onset than respondents without vomiting. These findings suggest that ill respondents may have the misconception that foodborne illness symptoms typically occur shortly after ingestion of contaminated food. Results suggest that education efforts should focus on the nature and timing of foodborne illness symptoms and the importance of reporting suspected foodborne illnesses.

Adult↗
PubMed2006

Food worker hand washing practices: an observation study.

Improvement of food worker hand washing practices is critical to the reduction of foodborne illness and is dependent upon a clear understanding of current hand washing practices. To that end, this study collected detailed observational data on food worker hand washing practices. Food workers (n = 321) were observed preparing food, and data were recorded on specific work activities for which hand washing is recommended (e.g., food preparation, handling dirty equipment). Data were also recorded on hand washing behaviors that occurred in conjunction with these work activities. Results indicated that workers engaged in approximately 8.6 work activities per hour for which hand washing is recommended. However, workers made hand washing attempts (i.e., removed gloves, if worn, and placed hands in running water) in only 32% of these activities and washed their hands appropriately (i.e., removed gloves, if worn, placed hands in running water, used soap, and dried hands) in only 27% of these work activities. Attempted and appropriate hand washing rates varied by work activity--they were significantly higher in conjunction with food preparation than other work activities (46 versus < or = 37% for attempted hand washing; 41 versus < or = 30% for appropriate hand washing) and were significantly lower in conjunction with touching the body than other work activities (13 versus > or = 27% for attempted hand washing; 10 versus > or = 23% for appropriate hand washing). Attempted and appropriate hand washing rates were significantly lower when gloves were worn (18 and 16%) than when gloves were not worn (37 and 30%). These findings suggest that the hand washing practices of food workers need to be improved, glove use may reduce hand washing, and restaurants should consider reorganizing their food preparation activities to reduce the frequency with which hand washing is needed.

Consumer Product Safety↗
PubMed1988

Botulism from chopped garlic: delayed recognition of a major outbreak.

Diagnosis of botulism in two teenaged sisters in Montreal led to the identification of 36 previously unrecognized cases of type B botulism in persons who had eaten at a restaurant in Vancouver, British Columbia, during the preceding 6 weeks. A case-control study implicated a new vehicle for botulism, commercial chopped garlic in soybean oil (P less than 10(-4)). Relatively mild and slowly progressive illness, dispersion of patients over at least eight provinces and states in three countries, and a previously unsuspected vehicle had contributed to prolonged misdiagnoses, including myasthenia gravis (six patients), psychiatric disorders (four), stroke (three), and others. Ethnic background influenced severity of illness: 60% of Chinese patients but only 4% of others needed mechanical ventilation (P less than 10(-3]. Trypsinization of serum was needed to show toxemia in one patient. Electromyography results with high-frequency repetitive stimulation corroborated the diagnosis of botulism up to 2 months after onset. Although botulism is a life-threatening disease, misdiagnosis may be common and large outbreaks can escape recognition completely.

Botulinum Toxins↗
PubMed2006

Meal size, not body size, explains errors in estimating the calorie content of meals.

BACKGROUND: Although most people underestimate the calories they consume during a meal or during the day, calorie underestimation is especially extreme among overweight persons. The reason for this systematic bias is unknown. OBJECTIVE: To investigate whether the association between calorie underestimation and body mass reflects a tendency for all persons to underestimate calories as the size of a meal increases. DESIGN: Overweight and normal-weight adults estimated the number of calories of a fast-food meal they had ordered and eaten (study 1) or of 15 fast-food meals that were chosen by the experimenter (study 2) in a randomized, controlled trial. Their estimations were compared with the actual number of calories of the meals. SETTING: Study 1 was a field study conducted in fast-food restaurants in 3 medium-sized midwestern U.S. cities. Study 2 was conducted in a laboratory at a major U.S. research university. PARTICIPANTS: Study 1 involved 105 lunchtime diners (average body mass index [BMI], 24.2 kg/m2 [range, 17.2 to 33.5 kg/m2]). Study 2 involved 40 undergraduate students (average BMI, 23.2 kg/m2 [range, 16.1 to 32.3 kg/m2]). MEASUREMENTS: Participants were asked to estimate the number of calories in a fast-food meal they had ordered and eaten (study 1) or in 15 sizes of the same fast-food meal (study 2). The actual number of calories in the meals in the field study was obtained by unobtrusively recording the food that was ordered (identified from the wrappings and containers). Weight and height were self-reported. RESULTS: Although participants strongly underestimated the number of calories in larger meals (by -38.0% in study 1 and by -22.6% in study 2), they almost perfectly estimated the number of calories in smaller meals (by -2.9% in study 1 and by 3.0% in study 2). After the authors controlled for body weight-related differences in meal size, the calorie estimations of normal-weight and overweight participants were identical in both studies. LIMITATIONS: These studies examined fast-food meals. Weight and height were self-reported. There were too few observations to distinguish between obese (BMI > or =30 kg/m2) and overweight (BMI >25 kg/m2 but <30 kg/m2) participants. CONCLUSIONS: Greater underestimation of calories by overweight persons is a consequence of their tendency to consume larger meals. Calorie underestimation is related to meal size, not body size.

Adult↗
PubMed1998

Training future chefs at Opryland.

Dina Starks is the culinary apprentice coordinator at Opryland Hotel Convention Center in Nashville, Tenn. Her apprentices have the unique opportunity to practice the culinary arts at the largest hotel convention center in the world, in a setting that has 15 restaurants and nearly 3,000 rooms.

Commerce↗
PubMed1999

Outbreaks of Shigella sonnei infection associated with eating fresh parsley--United States and Canada, July-August 1998.

In August 1998, the Minnesota Department of Health reported to CDC two restaurant-associated outbreaks of Shigella sonnei infections. Isolates from both outbreaks had two closely related pulsed-field gel electrophoresis (PFGE) patterns that differed only by a single band. Epidemiologic investigations implicated chopped, uncooked, curly parsley as the common vehicle for these outbreaks. Through inquiries to health departments and public health laboratories, six similar outbreaks were identified during July-August (in California [two], Massachusetts, and Florida in the United States and in Ontario and Alberta in Canada). Isolates from five of these outbreaks had the same PFGE pattern identified in the two outbreaks in Minnesota. This report describes the epidemiologic, traceback, environmental, and laboratory investigations, which implicated parsley imported from a farm in Mexico as the source of these outbreaks.

Apiaceae↗
PubMedDate not supplied

Formative evaluation of an Inspection Certificate Program (ICP) pilot in Toronto.

The inspection certificate program consists of food establishments voluntarily posting a certificate to inform patrons that inspection reports can be accessed from operators or the public health department. A three-month pilot program was evaluated for program improvement purposes. Only 65% of the selected operators were willing to participate, which suggests a challenge to fully implementing the program. Thirty-nine randomly selected restaurant operators participated. Most operators posted the certificate at the front entrance, and patrons indicated that reports were clear. Operators were supportive of the program. Some operators reported that the program was good for business and offered suggestions to improve it. A total of 583 requests for reports were made which suggests that the program empowered patrons to request reports, mostly from operators. Most patron evaluation forms came from a few operators that had no deficiencies, which limits generalizability.

Accreditation↗
PubMed2000

Illnesses associated with use of automatic insecticide dispenser units--selected states and United States, 1986-1999.

To control indoor flying insects, restaurants and other businesses commonly use pyrethrin and pyrethroid insecticides sprayed from automatic dispensing units. Usually placed near entrances, these units are designed to kill flying insects in food service or work areas. On May 18, 1999, the Florida Department of Health (FDH) was notified by the Florida Department of Business and Professional Regulation (DBPR) that during May 12-17, three persons developed pesticide-related illnesses associated with improperly placed automatic insecticide dispensers. After FDH conducted a follow-up investigation and notified CDC's National Institute for Occupational Safety and Health (NIOSH) of this event, surveillance data were reviewed to identify additional cases of pesticide-related illnesses associated with automatic insecticide dispensers. Data were provided by the Toxic Exposure Surveillance System (TESS), the California Department of Pesticide Regulation (CDPR), the Montana Department of Agriculture (MDA), the National Pesticide Telecommunications Network (NPTN), and the Washington State Department of Health (WSDH)*. This report describes cases, summarizes surveillance data for pesticide-related illnesses associated with automatic insecticide dispensers, and provides recommendations for safe dispenser use.

Adolescent↗
PubMedDate not supplied

[Noise and communal dining facilities].

Noise is a sound which is unwanted, either because of its effect on humans, its effect on fatigue or multifunctions of physical equipment, or its interference with the perception or detection of other sounds. It is a part of environmental pollution which can, in certain circumstances, reach worrying levels for the population (130 dB cause pain). Unsuitable exposure to noise for even short periods of time is responsible for symptomology involving the hearing organs (hypoacusis) and other parts of the body such as the cardiovascular, muscular and digestive systems via the connection between the central and the autonomous nervous systems. Noise in communal eating areas can be classed as coming from 3 sources: 1) operation of cooking machinery; 2) banging of pans and equipment; 3) voices of both staff and diners. The intensity of noise on these premises varies generally between 60 and 80 dB (discomfort threshold). The Regulations governing this subject are D.Lgs n.277 of 15/8/1991 regarding the protection of employees, D.P.C.M. of 1/3/1991 which establishes the maximum levels of noise both in the home and outside, and the more recent D.P.C.M. of 21/5/1999 referring to noise in public places, which includes restaurants. To contain the exposure to noise in public eating places, we believe that action should be taken at legal levels with stricter limits than the recently passed level of 105 dB, in the building planning departments and also with technological intervention in order to reduce the effects that noise has on the auditive and extra-auditive organs and thus limit possible sublimal messages which certainly do not benefit the psycho-physical well-being of the diners.

Cooking↗
PubMed2002

[Clostridium perfringens in raw and cooked meats and its relation with the environment in Costa Rica].

The presence of Clostridium perfringens in eight slaughter houses from Costa Rica was analyzed using the Most Probable Number (MPN) technique, in order to assess the risk of acquiring a food borne intoxication due to consumption of contaminated meat. C. perfringens was detected in 29 (88%) out of 33 soil samples collected from the slaughter house surroundings (average 6.7 x 10(2) MPN/g), as well as in 70 (93%) out of 75 intestinal contents of slaughtered animals (average 3 x 10(4) MPN/g), in 42 (55%) out of 76 samples of slaughtered meat (average 2.2 x 10(4) MPN/g) and in 30 (61%) out of 49 retail meats (average 8 x 10(3) MPN/g). In addition, the presence of this bacterium was evaluated in ten retail meat markets located in the Metropolitan Area of Costa Rica, where it was isolated from 15 (75%) out of 20 samples of ground meat and from 28 (36%) de 78 stew meat samples (average 1.9 x 10(3) and 7.5 x 10(2) MPN/g, respectively). Only one out of 35 samples of cooked meat obtained from 32 restaurants that utilize heated water baths (average temperature of 82 degrees C) was positive for C. perfringens (4 MPN/g, temperature 72 degrees C). Out of 1121 bacterial isolates obtained, 250 were evaluated for enterotoxigenicity. Only 3 (1.2%) of these tested positive for enterotoxin production, probably because most wild strains are not toxin producers, even though they can be induced to produce it as a result of repeated thermal shocks. The present results urge the adoption of adequate preventive measures and high sanitary standards in the meat processing industry in Costa Rica, in order to minimize the risk of food-borne intoxications caused by C. perfringens, due to its widespread distribution and potential human health hazard.

Abattoirs↗
PubMedDate not supplied

An outbreak of Bacillus cereus implicating a part-time banquet caterer.

CONTEXT AND OBJECTIVES: In the aftermath of a party, 70% (25 of 36) of attendees had gastroenteritis. The objectives of this study were to identify a risk factor associated with the food during the banquet and to identify measures of control for avoiding this kind of outbreak in the future. METHOD: A retrospective cohort study was used. We tried to reach by telephone all guests who had attended this banquet. A standardized questionnaire was used to provide information about identification of a risk factor, especially in relation to food. RESULTS: The cohort study has shown that potato salad served at the party was significantly associated with the disease. The mayonnaise used to prepare the salad was analyzed and Bacillus cereus was isolated (10(3) bacteria per gram). DISCUSSION: Bacillus microorganisms are usually found in decaying organic matter, dust, soil, vegetables and water. The bacteria has a remarkable ability to survive strong environmental stresses. There are strains of B. cereus that can cause food poisoning episodes with infective doses as low as 10(3) to 10(4) bacteria per gram. B. cereus is an infrequently reported cause of foodborne illnesses in Quebec and in North America but this may be due to underreporting of episodes. In this outbreak, bacterial multiplication was facilitated at several points in the interval between the preparation of the meal and the consumption of the banquet by the guests. Because the spores are ubiquitous and resistant to inactivation with most food grade disinfectants, temperature control should be the main focus of B. cereus outbreak prevention. CONCLUSION: The meal was prepared by a restaurateur who was inexperienced in catering services and temperature control in particular when food is served outside the restaurant. This outbreak underscores the importance of maintaining meticulous hygienic procedures in food processing. Restaurateurs who offer catering services should be familiar with the constraints that are specific to this sector of the food industry.

Bacillus cereus↗
PubMed2003

A national outbreak of infection with Salmonella enteritidis phage types 5c and 6a associated with Chinese food businesses in Scotland, summer 2000.

An outbreak of salmonellosis, involving cases of infection with Salmonella enteritidis phage types (PT) 5c and 6a, occurred across Scotland between May and August 2000. In total, 70 outbreak cases were microbiologically confirmed. Preliminary investigation suggested that consumption of food, especially chicken dishes, from Chinese restaurants or take-aways (food businesses) was a risk factor for infection. A matched case-control study demonstrated a statistically significant association (OR 22.4, P=0.0024) between infection and consumption of food from Chinese food businesses. A cohort study of novel design suggested that chicken was an important vehicle of infection. However the result did not reach statistical significance (OR 1.7, P=0.3). Extensive environmental investigation was unable to identify the source of the suspected contaminated chicken.

Animals↗
PubMed2004

Cultural and historical trends and influences of food, nutrition and cuisine on health and development.

The distinctive qualities of the cuisine of Hangzhou are the result of its geographical situation, which provided good soils, reliable rainfall, a lake that has been a water source and renowned beauty spot for centuries. The rich water-sources facilitated the development of gastronomy, agriculture, trade and administration, especially after it became the capital of the Southern Sung Dynasty. Hangzhou's food sources are especially diverse, notably for fish, green vegetables, fungi, and tofu, and have been since early records. As capital, it became a leader in cuisine, and in the development of the restaurant industry. The strength of food traditions has been reinforced constantly by the cultural, medicinal, nutritional, and social values of food and cooking, by the interest of Chinese scholars in food and wine, and by the narrative that accompanies specific dishes.

China↗