Modelling the use of different enforcement strategies to improve food safety

According to the General Food Law, food producers are responsible for the production of safe products. Safe in this regard is often interpreted as compliance to EU food safety legislation. The level of compliance between companies differs and can be improved by measures such as education or sanctions. In order to determine the effectiveness of various enforcement strategies on the level of compliance we developed a simulation tool using Agent Based Modelling (ABM) as a method

Extreme Heat Resistance of Food Borne Pathogens Campylobacter jejuni, Escherichia coli, and Salmonella typhimurium on Chicken Breast Fillet during Cooking

The aim of this research was to determine the decimal reduction times of bacteria present on chicken fillet in boiling water. The experiments were conducted with Campylobacter jejuni, Salmonella, and Escherichia coli. Whole chicken breast fillets were inoculated with the pathogens, stored overnight (4°C), and subsequently cooked. The surface temperature reached 70°C within 30 sec and 85°C within one minute. Extremely high decimal reduction times of 1.90, 1.97, and 2.20 min were obtained for C. jejuni, E. coli, and S. typhimurium, respectively. Chicken meat and refrigerated storage before cooking enlarged the heat resistance of the food borne pathogens. Additionally, a high challenge temperature or fast heating rate contributed to the level of heat resistance. The data were used to assess the probability of illness (campylobacteriosis) due to consumption of chicken fillet as a function of cooking time. The data revealed that cooking time may be far more critical than previously assumed

Designing the learning of intraprofessional collaboration among medical residents

Background To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements. Methods Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles. Results The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning. Conclusion This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements

Clinical and cost-effectiveness of computerised cognitive behavioural therapy for depression in primary care: Design of a randomised trial

<p>Abstract</p> <p>Background</p> <p>Major depression is a common mental health problem in the general population, associated with a substantial impact on quality of life and societal costs. However, many depressed patients in primary care do not receive the care they need. Reason for this is that pharmacotherapy is only effective in severely depressed patients and psychological treatments in primary care are scarce and costly. A more feasible treatment in primary care might be computerised cognitive behavioural therapy. This can be a self-help computer program based on the principles of cognitive behavioural therapy. Although previous studies suggest that computerised cognitive behavioural therapy is effective, more research is necessary. Therefore, the objective of the current study is to evaluate the (cost-) effectiveness of online computerised cognitive behavioural therapy for depression in primary care.</p> <p>Methods/Design</p> <p>In a randomised trial we will compare (a) computerised cognitive behavioural therapy with (b) treatment as usual by a GP, and (c) computerised cognitive behavioural therapy in combination with usual GP care. Three hundred mild to moderately depressed patients (aged 18–65) will be recruited in the general population by means of a large-scale Internet-based screening (<it>N </it>= 200,000). Patients will be randomly allocated to one of the three treatment groups. Primary outcome measure of the clinical evaluation is the severity of depression. Other outcomes include psychological distress, social functioning, and dysfunctional beliefs. The economic evaluation will be performed from a societal perspective, in which all costs will be related to clinical effectiveness and health-related quality of life. All outcome assessments will take place on the Internet at baseline, two, three, six, nine, and twelve months. Costs are measured on a monthly basis. A time horizon of one year will be used without long-term extrapolation of either costs or quality of life.</p> <p>Discussion</p> <p>Although computerised cognitive behavioural therapy is a promising treatment for depression in primary care, more research is needed. The effectiveness of online computerised cognitive behavioural therapy without support remains to be evaluated as well as the effects of computerised cognitive behavioural therapy in combination with usual GP care. Economic evaluation is also needed. Methodological strengths and weaknesses are discussed.</p> <p>Trial registration</p> <p>The study has been registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).</p

Modelling the use of different enforcement strategies to improve food safety

According to the General Food Law, food producers are responsible for the production of safe products. Safe in this regard is often interpreted as compliance to EU food safety legislation. The level of compliance between companies differs and can be improved by measures such as education or sanctions. In order to determine the effectiveness of various enforcement strategies on the level of compliance we developed a simulation tool using Agent Based Modelling (ABM) as a method.</p

Tolerance of clinical uncertainty by geriatric residents: a qualitative study

Contains fulltext : 204257.pdf (publisher's version ) (Open Access

Data analyses and modelling for risk based monitoring of mycotoxins in animal feed

Following legislation, European Member States should have multi-annual control programs for contaminants, such as for mycotoxins, in feed and food. These programs need to be risk based implying the checks are regular and proportional to the estimated risk for animal and human health. This study aimed to prioritize feed products in the Netherlands for deoxynivalenol and aflatoxin B1 monitoring. Historical mycotoxin monitoring results from the period 2007–2016 were combined with data from other sources. Based on occurrence, groundnuts had high priority for aflatoxin B1 monitoring; some feed materials (maize and maize products and several oil seed products) and complete/complementary feed excluding dairy cattle and young animals had medium priority; and all other animal feeds and feed materials had low priority. For deoxynivalenol, maize by-products had a high priority, complete and complementary feed for pigs had a medium priority and all other feed and feed materials a low priority. Also including health consequence estimations showed that feed materials that ranked highest for aflatoxin B1 included sunflower seed and palmkernel expeller/extracts and maize. For deoxynivalenol, maize products were ranked highest, followed by various small grain cereals (products); all other feed materials were of lower concern. Results of this study have proven to be useful in setting up the annual risk based control program for mycotoxins in animal feed and feed materials

Methods to perform risk-based inspections of food companies

Abstract: Risk-based monitoring programs are increasingly applied for cost-effective monitoring of food safety. Such programs ideally consist of three steps: risk-ranking, risk-based inspections, and cost-effective monitoring. Various methods have been described to perform the first step of risk-based monitoring. However, once the risk-ranking has been completed, identifying the hazard-food combinations to monitor, the frequency of inspection needs to be established based on a prioritization of food business operators (FBOs). The aim of this paper is to provide an overview of methods available for risk-based inspections. Literature shows that FBO's food safety compliance can be assessed based on company size, historical monitoring data, and socio-economic factors influencing compliance behavior. Non-compliance can either be intentional or unintentional. The latter can be assessed by evaluating the food safety culture of a company. Various models—ranging from qualitative (e.g., focus groups) to quantitative (e.g., scoring)—can be used for this purpose. These models usually include an evaluation of the organizational structure (e.g., management control, communication, commitment), the technical food safety environment (e.g., hygienic design, zoning), and employee characteristics (e.g., knowledge, risk awareness). Intentional non-compliance can be assessed using food fraud vulnerability tools. These tools incorporate factors influencing the likelihood of food fraud at the company, that is, opportunity, motivation, and (lack of) control measures. The literature indicates that either self-assessment tools or risk matrices are applied. There is no global consensus on the methods to apply for risk-based inspections. Depending on time and budget available as well as preferred output, one of the presented methods may be applied for prioritizing FBOs

Expert-driven methodology to assess and predict the effects of drivers of change on vulnerabilities in a food supply chain: Aquaculture of Atlantic salmon in Norway as a showcase

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