Older adults’ domestic kitchen practices associated with an increased risk of listeriosis

Older adults and other groups with weakened immunity are at increased risk of foodborne disease. Further research is important to understand the actual food safety practices of older adults and therefore develop effective food safety education strategies

The ship in the sky

The sky’s grumbling. Layers of gray grinding above me the way teeth grind, angry and wanting, all nap long. Two boom-clap bangs and my eyes snap open to clouds thick as clay, metal-sheet lightening and thunder thumping close and heavy as fists. I grab the stone floor and I’m watching and listening, listening and watching and I’m hearing yelling and it’s my own heart yelling, and I realize this ain’t dreaming. This ain’t dreaming. I ease myself near the rock ledge, hanging there like a loose tooth when the ground rips apart, it clear splits thirty feet in front of me right through the Joneses' veggie patch. My gut leaps to my throat. Would be an awesome sight if it weren’t so terrifying. Air and water and fire and earth dancing into one, blasting the ground inches from the Joneses’ farmhouse splitting their flagpole, my eardrums just about splitting in the roar. I clasp on tight. Next thing, my legs are falling from my body, or my body’s falling from the rock and we’re sinking together, sliding down. Then silence. Earth shattering silence. A venomous pause. Nothing moves, not even my lungs. I grab at the ledge hanging, waiting, watching. Come on Bill. Get out of the house. Get the Missus and get the fuck out. The elements are hovering, brewing a soup so thick and dark a rich thick and dark soup. Triple decker boom and I’m rolling to the spine of the rock as it tilts and digs its feet in, crushing or protecting, as the sky breaks open with rain belting down. I crank my head towards the farmhouse and it’s sinking. Come on Bill and Betty. As the sky belts the earth belts my skull belts on the back of that blasted crushing protecting rock, the ground sinking further under the weight from above and rock falling, consciousness too, and then I’m dreaming of everything

Ivermectin for onchocercal eye disease (river blindness).

BACKGROUND: It is believed that ivermectin (a microfilaricide) could prevent blindness due to onchocerciasis. However, when given to everyone in communities where onchocerciasis is common, the effects of ivermectin on lesions affecting the eye are uncertain and data on whether the drug prevents visual loss are unclear. OBJECTIVES: The aim of this review was to assess the effectiveness of ivermectin in preventing visual impairment and visual field loss in onchocercal eye disease. The secondary aim was to assess the effects of ivermectin on lesions affecting the eye in onchocerciasis. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 3), MEDLINE (January 1950 to April 2012), EMBASE (January 1980 to April 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 April 2012. SELECTION CRITERIA: We included randomised controlled trials with at least one year of follow-up comparing ivermectin with placebo or no treatment. Participants in the trials were people normally resident in endemic onchocercal communities with or without one or more characteristic signs of ocular onchocerciasis. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed trial quality. We contacted study authors for additional information. As trials varied in design and setting, we were unable to perform a meta-analysis. MAIN RESULTS: The review included four trials: two small studies (n = 398) in which people with onchocercal infection were given one dose of ivermectin or placebo and followed up for one year; and two larger community-based studies (n = 4941) whereby all individuals in selected communities were treated every six or 12 months with ivermectin or placebo, whether or not they were infected, and followed for two to three years. The studies provide evidence that treating people who have onchocerciasis with ivermectin reduces the number of microfilariae in their skin and eye(s) and reduces the number of punctate opacities. There was weaker evidence that ivermectin reduced the risk of chorioretinitis. The studies were too small and of too short a duration to provide evidence for an effect on sclerosing keratitis, iridocyclitis, optic nerve disease or visual loss. One community-based study in communities mesoendemic for the savannah strain of O.volvulus provided evidence that annual mass treatment with ivermectin reduces the risk of new cases of optic nerve disease and visual field loss. The other community-based study of mass biannual treatment of ivermectin in communities affected by the forest strain of O.volvulus demonstrated reductions in microfilarial load, punctate keratitis and iridocyclitis but not sclerosing keratitis, chorioretinitis, optic atrophy or visual impairment. The study was underpowered to estimate the effect of ivermectin on visual impairment and other less frequent clinical signs. The studies included in this review reported some adverse effects, in particular an increased risk of postural hypotension in people treated with ivermectin. AUTHORS' CONCLUSIONS: The lack of evidence for prevention of visual impairment and blindness should not be interpreted to mean that ivermectin is not effective, however, clearly this is a key question that remains unanswered. The main evidence for a protective effect of mass treatment with ivermectin on visual field loss and optic nerve disease comes from communities mesoendemic for the savannah strain of O.volvulus. Whether these findings can be applied to communities with different endemicity and affected by the forest strain is unclear. Serious adverse effects were rarely reported. None of the studies, however, were conducted in areas where people are infected with Loa loa (loiasis)

Teens, Video Games, and Civics

Analyzes survey findings on trends in teenagers' video gaming, the social context, the role of parents and monitoring, and the link between specific gaming experiences and civic activities. Explores gaming's potential as civic learning opportunities

Comparison of listeriosis risk factors among three ‘at-risk’ consumer groups: pregnant women, older adults and chemotherapy patients

Introduction: Due to weakened immune function, listeriosis is particularly associated with ‘at-risk’ consumers, predominantly affecting pregnant-women, older-adults (aged ≥ 60 years) and people receiving chemotherapy. Sporadic incidence of listeriosis is frequently related to refrigerated ready-to-eat (RTE) food products stored/consumed in the domestic kitchen. Consequently, ‘at-risk’ consumers should implement safe food handling/storage practices, including time and temperature control of RTE-foods to reduce the risks associated with L. monocytogenes. Changes in UK epidemiology data indicate reduced pregnancy associated-cases and increased older-adult and chemotherapy associated-cases. Purpose: Determination and comparison of these ‘at-risk’ consumers’ food-safety reported behaviours and related cognitions may identify listeriosis risk factors and inform the development of targeted food-safety information. Such data is currently lacking in the UK. Methods: Quantitative survey methods (online/paper-based) ascertained food-safety knowledge, self-reported practices and attitudes towards domestic food handling/storage. The study involved pregnant/post-partum (≤12 months) women (n=40), older-adults (≥60 years) (n=100) and chemotherapy-patients/family-caregivers (n=172). Results: Awareness of recommended refrigeration temperatures were significantly more widespread(p0.05), with the majority (58-65%) reporting temperatures would ‘never’ be checked. Older-adults were significantly less knowledgeable of ‘use-by’ dates, had more negative attitudes (p<0.001) towards ‘use-by’ dates and were more likely to report consumption of foods beyond the ‘use-by’ date (p<0.005). Although older-adults’ attitudes were significantly more negative towards consuming RTE foods within two days of opening, no significant differences in knowledge and self-reported practices were determined, with majority of all ‘at-risk’ consumers (82-89%) reporting consumption beyond recommendations. Failing to adhere to recommended food storage practices may increase the risks associated with listeriosis among these ‘at-risk’ consumers. Significance: Significant differences in knowledge, attitudes and self-reported practices between ‘at-risk’ consumers may indicate why reduced pregnancy associated-cases and increased older-adult and chemotherapy associated-cases are reported in the UK. Study findings may be utilised for the development of targeted food-safety education to reduce risks of listeriosis

Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products

Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured

A Review of UK Food Safety Information Provision for Chemotherapy Patients

Introduction: Chemotherapy patients have an increased risk of foodborne illnesses as a result of immunosuppression, and are reported to have a five-times greater risk of listeriosis. To enable chemotherapy patients/carers to minimise risk of illness by implementation of risk-reducing behaviours is essential. Provision of food safety information prior to and during treatment is needed to raise awareness of the potential risks relating to foodborne illness by informing patients/carers of control measures and responsibilities of reducing critical risk factors. Purpose: The aim of this study was to review food-related information available to chemotherapy patients/carers in the UK and evaluate the inclusion of risk-reducing food-safety behaviours. Methods: Food-related information available to chemotherapy patients/carers in the UK were collected from health care providers including UK NHS trusts. Sources were reviewed and analysed using a content analysis approach. Findings were summarized according to key topics critical to food safety and listeriosis, (e.g. refrigeration practices, cross-contamination, consumption of at-risk food products). Results: Overall, food-related information for cancer patients was obtained from 42 of 141 NHS chemotherapy providers and three UK cancer charities. Although 64% explained why patients are at an increased risk of developing infection during treatment, many failed to highlight the importance of food safety to prevent infection. Recommendations to ensure thorough cooking were most frequently included, although 42% recommended the avoidance of raw meat, poultry and fish, only 9% recommended the use of a thermometer to achieve a core temperature of 75°C. Practices relating to avoiding listeriosis were particularly lacking. Significance: Although information is available, considerable gaps exist and information provided varies greatly between sources. There is a need to establish the potential impact of such food-related information sources on cancer patient/carer food safety knowledge, attitudes towards reducing the risks of foodborne disease during chemotherapy treatment and implementation of risk-reducing food safety practices in the home during chemotherapy. Such data will inform the development of food safety education interventions targeting patients/carers

An assessment of food safety information provision for UK chemotherapy patients to reduce the risk of foodborne infection

Objectives: Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection are limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients. Study Design: In-depth semi-structured interviews and content-analysis of online patient information resources. Methods: Interviews with patients and family caregivers (n=15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n=45) were obtained from 35 of 154 National Health Service (NHS) chemotherapy providers in England, Scotland and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients. Results: In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient and varied between resources. Conclusion: The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients

A review of consumer food safety research to identify domestic risk factors associated with listeriosis

Introduction: Listeriosis is associated with the highest hospitalization and mortality rates of foodborne illnesses; listeriosis incidence has doubled in recent years in Europe. Consumer recommendations to reduce listeriosis risk factors include following ‘use-by’ dates on unopened ready-to-eat (RTE) food products, avoiding prolonged storage of opened RTE foods and ensuring safe refrigeration temperatures. Currently, data detailing consumer cognition and behaviour associated with listeriosis risk factors are lacking. Purpose: This study aimed to review consumer food safety studies to consolidate and cumulatively determine consumer cognitive and behavioural risk factors that may be associated with listeriosis in the home. Methods: Consumer food safety research data (n=200) were reviewed and analysed using a content analysis approach. Findings were summarized according to assessment of knowledge, attitudes, self-reported practices, and/or actual behaviours of listeriosis risk factors. Results: Overall, only 43% of studies assessed consumer cognitive or behavioural data associated with listeriosis risk factors; 27% assessed refrigeration practices, 23% determined storage length of opened RTE foods and 21% ascertain adherence of ‘use-by’ dates. Majority (71%) of studies utilized survey based data collection methods (questionnaires/interviews), consequently, the majority of findings were based on self-report (78%) and knowledge (59%). Observation (21%) and focus groups (8%) were less commonly used. Consequently findings of this study indicate that actual behaviours and attitudinal data relating to listeriosis risk factors are lacking. Although findings suggest consumers may deviate from recommended practices, a lack of observational data suggests a need to determine the actual behaviours of consumers in domestic kitchens in relation to listeriosis risk factors. Significance: This review reveals a need for in-depth research to determine food safety attitudes and actual behaviours of consumers in conjunction with self-reported practices and knowledge of listeriosis risk factors. Such data combined with review findings would inform development of targeted food safety education to reduce risks associated with listeriosis in the home