Food safety knowledge and practice among elderly people living at home

Food safety in the aging population: Qualitative findings on what to communicate and how

The present study investigated older adults' risk perception, beliefs, and self-perception in the field of kitchen hygiene and food safety. A qualitative study with semi-structured focus groups was conducted. A total of 37 older adults (60-80 years of age) from Germany participated in four focus groups that were stratified by gender. Focus groups covered older adults' food-handling practices, their perceptions of vulnerability, and their informational needs in the field of food safety. A thematic analysis approach was adopted. The coding categories and subcategories were developed inductively by the researchers based on the data. The coded data were then used to identify overarching themes and subthemes. Main results showed that older adults had confidence in their knowledge and skills with regard to food safety, perceived their post-war generation overall to be resistant and other so-called at-risk groups to be more vulnerable. Moreover, they expressed low informational needs in the area of food safety. The results suggest that age-specific aspects play a role in older adults' risk perception and highlight the need to develop age-specific risk communication strategies that take into account older adults' beliefs, knowledge, and informational needs.

Implications of refrigerator management on subjective memory complaints among Japanese community-dwelling older adults

AIM

Older adults with subjective memory complaints (SMC) may experience very minor difficulties in daily activities. Although caregivers and occupational therapists who support community-dwelling older adults are aware of the existence of characteristic behaviours related to refrigerator management, no specific studies have been conducted. This study aimed to examine the implications of refrigerator management for older adults with SMC.

METHODS

A self-administered questionnaire was sent to 3000 randomly selected members of Consumer's Co-operative Kagoshima. Of the returned responses, a total of 282 older adults were analyzed. Analyzed subjects were divided into two groups: SMC (+) group (n = 74) and SMC (-) group (n = 192). A questionnaire was created by four occupational therapists and used to assess the characteristics of analyzed subjects and their abilities to manage the refrigerator. The observation list for early signs of dementia was also utilised. A multiple logistic analysis was performed to examine the association between SMC and refrigerator management.

RESULTS

The SMC (+) group had a significantly higher number of refrigerator management errors than the SMC (-) group (P = 0.008). The SMC (+) group had more errors than the SMC (-) group in the following four items regarding refrigerator management; the refrigerator has a lot of the same foods / expired food, the person does not know what's in the refrigerator, the person cannot find what he/she needs in the refrigerator. Moreover, SMC was associated with the item 'the person does not know what is in the refrigerator' (odds ratio 7.44, 95% CI 1.51-43.8, P = 0.02).

CONCLUSIONS

Our results showed that older adults with SMC had several problems regarding refrigerator management. Evaluating refrigerator management among older adults with SMC may help consider multifaceted support.

Consumers’ Knowledge and Handling Practices Associated with Fresh-Cut Produce in the United States

Previous studies have shown that three factors influence fresh-cut produce safety from farm to fork: (1) post-harvest practices in processing facilities, (2) employees’ handling practices in retail facilities, and (3) consumers’ handling practices in domestic kitchens or cooking facilities. However, few studies have examined consumers’ food safety knowledge, risk perceptions, and their handling practices associated with fresh-cut produce. To fill this gap, the present study conducted a nationwide survey to assess U.S. consumers’ food safety knowledge, practices, and risk perception associated with fresh-cut produce among various demographic groups and investigated factors influencing consumers’ food safety practices related to fresh-cut produce. The results showed that consumers lack the knowledge and safe handling practices toward fresh-cut produce regarding storage hierarchy, surface cleaning and sanitizing, and time and temperature control of fresh-cut produce. The men and millennial consumers exhibit a lower level of safe fresh-cut produce handling practices. In addition, a significant interaction was observed between food safety knowledge and risk perceptions on consumers’ fresh-cut produce handling practices, such that food safety knowledge can transfer to practice more effectively for consumers with high levels of risk perception. The results can be utilized to design effective consumer food safety education tools for targeted audiences.

Difficulties in the Use of Everyday Technology among Older Adults with Subjective Memory Complaint and Cognitive Decline

INTRODUCTION

The ability to use everyday technology (ET) is becoming increasingly necessary for maintaining domestic and social lives. For older adults, difficulties with using ETs can begin at the mild cognitive impairment (MCI) state and may indicate increasing cognitive decline. The aim of this study was to conduct a detailed investigation into the ability to use ETs among Japanese older community-dwelling adults at 3 stages of cognitive function and the ability to carry out daily activities.

METHOD

We analyzed family members' responses to questions about older adults with cognitive decline in their families. A total of 168 older adults with subjective memory complaints (SMC) or cognitive decline and inconvenience in daily life were analyzed. A questionnaire was used to assess the characteristics, ability to use ETs, and ability to manage refrigerator contents, all of which can be early signs of dementia. Participants were divided 3 groups by the type of dementia: SMC (n = 77), MCI (n = 36), and Alzheimer's disease (AD) (n = 55) for comparison.

RESULT

The observation list of early signs of dementia (OLD) total score indicated a significant positive correlation with the number of ET errors (r = 0.37, p < 0.001) and number of difficulties with refrigerator management (r = 0.18, p = 0.031). Regarding number of ET errors, there was a significant main effect for the 3 groups, and the SMC group made significantly fewer errors than the AD group (p = 0.02). In 7 of the 11 ET categories, errors with using ETs were associated with all 3 groups, with the SMC group making fewer errors, and the AD group making more. Regarding difficulties with refrigerator management, 2 out of 9 problems were associated with the 3 groups, with the SMC group having fewer difficulties and the AD group having more.

DISCUSSION/CONCLUSION

The results indicated that the ability to use ETs and to manage refrigerator contents begins to decline at the SMC stage. Further evaluation of the ability to use ETs is needed for older adults with SMC so that adequate support in the context of the individual can be provided.

Guidance on date marking and related food information: part 1 (date marking)

A risk-based approach was developed to be followed by food business operators (FBO) when deciding on the type of date marking (i.e. 'best before' date or 'use by' date), setting of shelf-life (i.e. time) and the related information on the label to ensure food safety. The decision on the type of date marking needs to be taken on a product-by-product basis, considering the relevant hazards, product characteristics, processing and storage conditions. The hazard identification is food product-specific and should consider pathogenic microorganisms capable of growing in prepacked temperature-controlled foods under reasonably foreseeable conditions. The intrinsic (e.g. pH and aw), extrinsic (e.g. temperature and gas atmosphere) and implicit (e.g. interactions with competing background microbiota) factors of the food determine which pathogenic and spoilage microorganisms can grow in the food during storage until consumption. A decision tree was developed to assist FBOs in deciding the type of date marking for a certain food product. When setting the shelf-life, the FBO needs to consider reasonably foreseeable conditions of distribution, storage and use of the food. Key steps of a case-by-case procedure to determine and validate the shelf-life period are: (i) identification of the relevant pathogenic/spoilage microorganism and its initial level, (ii) characterisation of the factors of the food affecting the growth behaviour and (iii) assessment of the growth behaviour of the pathogenic/spoilage microorganism in the food product during storage until consumption. Due to the variability between food products and consumer habits, it was not appropriate to present indicative time limits for food donated or marketed past the 'best before' date. Recommendations were provided relating to training activities and support, using 'reasonably foreseeable conditions', collecting time-temperature data during distribution, retail and domestic storage of foods and developing Appropriate Levels of Protection and/or Food Safety Objectives for food-pathogen combinations.

A mathematical modeling approach to the quantification of lactic acid bacteria in vacuum-packaged samples of cooked meat: Combining the TaqMan-based quantitative PCR method with the plate-count method

The TaqMan-based quantitative Polymerase Chain Reaction (qPCR) method and the Plate Count (PC) method are both used in combination with primary and secondary mathematical modeling, to describe the growth curves of Leuconostoc mesenteroides and Weissella viridescens in vacuum-packaged meat products during storage under different isothermal conditions. Vacuum-Packaged Morcilla (VPM), a typical cooked blood sausage, is used as a representative meat product, with the aim of improving shelf-life prediction methods for those sorts of meat products. The standard curves constructed by qPCR showed good linearity between the cycle threshold (C_T) and log₁₀ CFU/g, demonstrating the high precision and the reproducible results of the qPCR method. The curves were used for the quantification of L. mesenteroides and W. viridescens in artificially inoculated VPM samples under isothermal storage (5, 8, 13 and 18 °C). Primally, both the qPCR and the PC methods were compared, and a linear regression analysis demonstrated a statistically significant linear correlation between the methods. Secondly, the Baranyi and Roberts model was fitted to the growth curve data to estimate the kinetic parameters of L. mesenteroides and W. viridescens under isothermal conditions, and secondary models were used to establish the dependence of the maximum specific growth rate on the temperature. The results proved that primary and secondary models were adequate for describing the growth curves of both methods in relation to both bacteria. In conclusion, the results of all the experiments proved that the qPCR method in combination with the PC method can be used to construct microbial growth kinetics and that primary and secondary mathematical modeling can be successfully applied to describe the growth of L. mesenteroides and W. viridescens in vacuum-packaged morcilla and, by extension, other cooked meat products with similar characteristics.

Effect of cold chain interruptions on the shelf-life of fluid pasteurised skim milk at the consumer stage

Abstract This study aimed to verify the effect of time and temperature abuse on bacterial numbers in fluid pasteurized skim milk by simulating the real-life scenario, which usually occurs when cold chain is interrupted by consumers prior to consumption that affect the shelf-life of milk. Total three trials were carried out in this study. Thermal abuse was simulated with temperature fluctuations from 5 °C. In the first trial, the information about holding the milk samples for 8 hours at three different temperatures of 15 °C, 20 °C and 25 °C was obtained using a data logger to predict the effect of temperature abuse on the milk microbial quality. Further, in the second and third trial, the effect of temperature abuse on bacterial numbers was examined by holding milk at 5 °C and then shifts temperature to 25 °C for 8 h and 6 h. The pH was monitored during storage. The total bacterial count was examined by the Standard Plate Count (SPC). The mean air temperature had the greatest impact on milk temperature. It took 3.0 h, 3.9 h and 4.2 h to warm up when exposed to the temperatures of 15 °C, 20 °C and 25 °C, respectively. The holding time of 8 h at 25 °C showed that bacterial numbers (1 x 105 CFU mL-1) were higher after 14 days of storage, but control samples at 5 °C (< 1 x 104 CFU mL-1) were still within the acceptable level (5 x 104 CFU mL-1). A holding time of 6 h at 25 oC showed much higher bacterial numbers (1 x 109 CFU mL-1) compared to control samples (1 x 107 CFU mL-1) which were held at 5 °C for 11 days. The pH of the milk decreased with increasing bacterial growth during the extended storage time. The results show that temperature abuse has a significant effect on milk microbial stability and shelf life. It is important to maintain the milk temperature at 5 °C or less as the bacterial growth directly depend on increasing temperature and holding time, which pose the potential risk of microbial hazards leading to foodborne illness. Thus, consumers must understand the factors associated with the safe handling of milk to keep it safe to use before the expiry date.

Listeria monocytogenes contamination of ready-to-eat foods and the risk for human health in the EU

Food safety criteria for Listeria monocytogenes in ready-to-eat (RTE) foods have been applied from 2006 onwards (Commission Regulation (EC) 2073/2005). Still, human invasive listeriosis was reported to increase over the period 2009-2013 in the European Union and European Economic Area (EU/EEA). Time series analysis for the 2008-2015 period in the EU/EEA indicated an increasing trend of the monthly notified incidence rate of confirmed human invasive listeriosis of the over 75 age groups and female age group between 25 and 44 years old (probably related to pregnancies). A conceptual model was used to identify factors in the food chain as potential drivers for L. monocytogenes contamination of RTE foods and listeriosis. Factors were related to the host (i. population size of the elderly and/or susceptible people; ii. underlying condition rate), the food (iii. L. monocytogenes prevalence in RTE food at retail; iv. L. monocytogenes concentration in RTE food at retail; v. storage conditions after retail; vi. consumption), the national surveillance systems (vii. improved surveillance), and/or the bacterium (viii. virulence). Factors considered likely to be responsible for the increasing trend in cases are the increased population size of the elderly and susceptible population except for the 25-44 female age group. For the increased incidence rates and cases, the likely factor is the increased proportion of susceptible persons in the age groups over 45 years old for both genders. Quantitative modelling suggests that more than 90% of invasive listeriosis is caused by ingestion of RTE food containing > 2,000 colony forming units (CFU)/g, and that one-third of cases are due to growth in the consumer phase. Awareness should be increased among stakeholders, especially in relation to susceptible risk groups. Innovative methodologies including whole genome sequencing (WGS) for strain identification and monitoring of trends are recommended.

Analysis of older adults' domestic kitchen storage practices in the United Kingdom: identification of risk factors associated with listeriosis

Increased listeriosis incidence among older adults (≥ 60 years) has been reported internationally, with many cases reported to be sporadic and associated with ready-to-eat (RTE) food products with extended refrigerated shelf life. Given that the home kitchen is recognized as a significant location where foodborne illnesses are acquired, it is important that consumers implement safe food practices to minimize risks. This is crucial for vulnerable consumers, such as older adults. Consumer food safety recommendations in the United Kingdom to reduce the risk of listeriosis at home include (i) following "use-by" dates on unopened prepacked RTE food products, (ii) consuming RTE food products within 2 days of opening, and (iii) ensuring the safe operating temperatures of domestic refrigerators (≤ 5 °C). This study utilized observation, self-reporting, and microbiological analysis to determine actual food storage practices to identify behavioral risk factors. A domestic kitchen survey was conducted in older adult (≥ 60 years) consumers' domestic kitchens (n = 100) in South Wales, United Kingdom. Forty-one percent of foods in home refrigerators were beyond the use-by date, of which 11% were unopened RTE food products commonly associated with listeriosis. Sixty-six percent of opened RTE foods had been or were intended to be stored beyond the recommended 2 days after opening. Older adults failed to ensure safe refrigeration temperatures, with 50% of central storage and 85% of door storage areas operating at temperatures >5 °C. Older refrigerators operated at significantly (P < 0.05) higher temperatures. Given that Listeria monocytogenes was isolated in 2% of kitchens, these findings suggest that storage malpractices may have a greater effect on the potential risk of listeriosis than its presence alone. The study has determined that many older adults fail to adhere to recommendations and subject RTE foods associated with L. monocytogenes to prolonged storage at unsafe temperatures which may render food unsafe for consumption.

The impact of socioeconomic status on foodborne illness in high-income countries: a systematic review

Foodborne illness is a major cause of morbidity and loss of productivity in developed nations. Although low socioeconomic status (SES) is generally associated with negative health outcomes, its impact on foodborne illness is poorly understood. We conducted a systematic review to examine the association between SES and laboratory-confirmed illness caused by eight important foodborne pathogens. We completed this systematic review using PubMed for all papers published between 1 January 1980 and 1 January 2013 that measured the association between foodborne illness and SES in highly developed countries and identified 16 studies covering four pathogens. The effect of SES varied across pathogens: the majority of identified studies for Campylobacter, salmonellosis, and E. coli infection showed an association between high SES and illness. The single study of listeriosis showed illness was associated with low SES. A reporting bias by SES could not be excluded. SES should be considered when targeting consumer-level public health interventions for foodborne pathogens.

Acute oral safety study of sodium caseinate glycosylated via maillard reaction with galactose in rats

In order to potentially use sodium caseinate (SC) glycated with galactose (Gal) in the food industry as a new functional ingredient with proved technological and biological properties, an evaluation of oral acute toxicity has been carried out. An acute safety study with SC-Gal glycoconjugates in the Wistar rat with a single oral gavage dose of 2,000 mg/kg of body weight was conducted. The SC-Gal glycoconjugates were well tolerated; no adverse effects or mortality was observed during the 2-week observation period. No abnormal signs, behavioral changes, body weight changes, or alterations in food and water consumption occurred. After this period, no changes in hematological and serum chemistry parameters, organ weights, or gross pathology or histopathology were detected. It was concluded that SC-Gal glycoconjugates obtained via the Maillard reaction were well tolerated in rats at an acute oral dose of 2,000 mg/kg of body weight. The SC-Gal glycoconjugates have a low order of acute toxicity, and the oral 50 % lethal dose for male and female rats is in excess of 2,000 mg/kg of body weight.

Behavioral risk factors associated with listeriosis in the home: a review of consumer food safety studies

Listeria monocytogenes causes human listeriosis, which is associated with the highest hospitalization and mortality rates of all foodborne illnesses. In recent years, the incidence of listeriosis has doubled in Europe, almost exclusively among older adults (≥ 60 years of age). Food safety factors associated with increased risk of listeriosis include lack of adherence to "use by" dates and ineffective refrigerated storage of foods. Consequently, older adult consumers' implementation of safe food practices should be evaluated. This article is a review of consumer food safety cognitive and behavioral data relating to risk factors associated with listeriosis in the home as reported in 165 consumer food safety studies. Overall, only 41% of studies included assessment of consumer cognitive or behavioral data associated with listeriosis; of these studies 59% included data on safe refrigeration, 54% included data on storage time for opened ready-to-eat foods, and 49% included data on adherence to use-by dates. In most (83%) of the studies, survey-based data collection methods (questionnaires/interviews) were used; thus, the majority of findings were based on self-report (74%) and knowledge (44%). Observation (31%) and focus groups (12%) were less commonly used, resulting in a lack of actual behaviors and attitudinal data relating to listeriosis risk factors. Only 7% of studies included food safety data for older adults. Although older adults may fail to implement recommended practices, this review reveals a need for in-depth research to determine food safety attitudes and actual behaviors of older adults in conjunction with knowledge and selfreport of practices linked to increased risks of listeriosis. Such data combined with review findings would inform targeted food safety education to reduce risks associated with listeriosis in the home.

Foodborne and waterborne infections in elderly community and long-term care facility residents,Victoria, Australia

We calculated rates of foodborne and waterborne infections reported to the health department in Victoria, Australia, during 2000-2009 for elderly residents of long-term care facilities (LTCFs) and the community. We used negative binomial regression to estimate incidence rate ratios, adjusting for age, sex, and reporting period. We analyzed 8,277 infections in elderly persons. Rates of campylobacteriosis, legionellosis, listeriosis, toxigenic Escherichia coli infections, and shigellosis were higher in community residents, and rates of Salmonella infection were higher in LTCF residents. Each year, 61.7 Campylobacter infections were reported per 100,000 LTCF residents, compared with 97.6 per 100,000 community residents. LTCF residents were at higher risk for S. enterica serotype Typhimurium associated with outbreaks. Rates of foodborne infections (except salmonellosis) were similar to or lower for LTCF residents than for community residents. These findings may indicate that food preparation practices in LTCFs are safer than those used by elderly persons in the community.

Burger preparation: what consumers say and do in the home

Ground beef has been linked to outbreaks of pathogenic bacteria like Escherichia coli O157:H7 and Salmonella. Consumers may be exposed to foodborne illness through unsafe preparation of ground beef. Video footage of 199 volunteers in Northern California preparing hamburgers and salad was analyzed for compliance with U.S. Department of Agriculture recommendations and for violations of the U.S. Food and Drug Administration's Food Code 2009. A questionnaire about consumer attitudes and knowledge about food safety was administered after each filming session. The majority of volunteers, 78%, cooked their ground beef patties to the Food Code 2009 recommended internal temperature of 155°F (ca. 68°C) or above, and 70% cooked to the U.S. Department of Agriculture consumer end-point guideline of 160°F (ca. 71°C), with 22% declaring the burger done when the temperature was below 155°F. Volunteers checked burger doneness with a meat thermometer in 4% of households. Only 13% knew the recommended internal temperature for ground beef. The average hand washing time observed was 8 s; only 7% of the hand washing events met the recommended guideline of 20 s. Potential cross-contamination was common, with an average of 43 events noted per household. Hands were the most commonly observed vehicle of potential cross-contamination. Analysis of food handling behaviors indicates that consumers with and without food safety training exposed themselves to potential foodborne illness even while under video observation. Behaviors that should be targeted by food safety educators are identified.

Incidence and contamination level of Listeria monocytogenes and other Listeria spp. in ready-to-eat meat products in Jordan

The objective of the present study was to investigate the incidence and contamination levels of different Listeria monocytogenes serovars in ready-to-eat meat products (RTE-MP) collected from different outlets and processing plants in Jordan in order (i) to provide information to Jordanian health authorities on the incidence of L. monocytogenes in RTE-MP sold and consumed in Jordan and (ii) to ascertain the risks of these products for consumers. Two hundred forty RTE-MP samples, 120 beef and 120 poultry, were analyzed. European International Organization for Standardization (EN ISO) 11290-1 and -2 standard protocols were used for detection and enumeration of L. monocytogenes. The identity of suspected L. monocytogenes was confirmed using PCR. Three Listeria spp., L. monocytogenes, L. innocua, and L. welshimeri, were isolated. L. innocua and L. welshimeri were the most and least frequently isolated with 56 and 36 samples, respectively. L. monocytogenes was isolated from 41 samples (17.1%): 23 from beef and 18 from poultry samples. The contamination levels of L. monocytogenes were <or=100 CFU/g in 97.5% (40 samples) of the positive samples. Only one beef sample with a count of >100 CFU/g was found. The L. monocytogenes strains isolated fell into two serotypes (1 and 4) and four different serovars (1/2a, 1/2b, 1/2c, and 4b).

Probabilistic model for Listeria monocytogenes growth during distribution, retail storage, and domestic storage of pasteurized milk

A survey on the time-temperature conditions of pasteurized milk in Greece during transportation to retail, retail storage, and domestic storage and handling was performed. The data derived from the survey were described with appropriate probability distributions and introduced into a growth model of Listeria monocytogenes in pasteurized milk which was appropriately modified for taking into account strain variability. Based on the above components, a probabilistic model was applied to evaluate the growth of L. monocytogenes during the chill chain of pasteurized milk using a Monte Carlo simulation. The model predicted that, in 44.8% of the milk cartons released in the market, the pathogen will grow until the time of consumption. For these products the estimated mean total growth of L. monocytogenes during transportation, retail storage, and domestic storage was 0.93 log CFU, with 95th and 99th percentiles of 2.68 and 4.01 log CFU, respectively. Although based on EU regulation 2073/2005 pasteurized milk produced in Greece belongs to the category of products that do not allow the growth of L. monocytogenes due to a shelf life (defined by law) of 5 days, the above results show that this shelf life limit cannot prevent L. monocytogenes from growing under the current chill chain conditions. The predicted percentage of milk cartons-initially contaminated with 1 cell/1-liter carton-in which the pathogen exceeds the safety criterion of 100 cells/ml at the time of consumption was 0.14%. The probabilistic model was used for an importance analysis of the chill chain factors, using rank order correlation, while selected intervention and shelf life increase scenarios were evaluated. The results showed that simple interventions, such as excluding the door shelf from the domestic storage of pasteurized milk, can effectively reduce the growth of the pathogen. The door shelf was found to be the warmest position in domestic refrigerators, and it was most frequently used by the consumers for domestic storage of pasteurized milk. Furthermore, the model predicted that a combination of this intervention with a decrease of the mean temperature of domestic refrigerators by 2 degrees C may allow an extension of pasteurized milk shelf life from 5 to 7 days without affecting the current consumer exposure to L. monocytogenes.

Good nutritional practice from producer to consumer

Today we manage food safety through good practices at different levels of food production, distribution, and consumption. The paper analyses current good practices, parameters involved in the food safety circle along the food supply chain, and consumer dilemmas. As a result of the current situation the new approach called "Good Nutritional Practice" (GNP) is proposed to balance the food safety systems. It is shown how important it is to integrate actual the food safety solutions within GNP, which includes consumers, and is based on a model that covers subsystems from other relevant good practices (nine good practices along the food supply chain). It has been shown that present maintenance of food safety in the food supply chain can be easily broken down, because of the different kinds of barriers or a simple misunderstanding among stakeholders including consumers.

Survey of temperature and consumption patterns of fresh-cut leafy green salads: risk factors for listeriosis

Increasing demand for fresh-cut or ready-to-eat fruits and vegetables, developed to meet the consumer need for quick and convenient products, has prompted extensive research into their microbiological quality, safety, processing, and packaging. The microbial ecology of Listeria monocytogenes is recognized as a major safety concern for fresh-cut produce. A survey was performed to collect information on consumption patterns of fresh-cut leafy green salads and the temperature of domestic refrigerators. Salad consumption was low-moderate: 24.3% of respondents never purchased fresh-cut leafy green salads; of those who reported buying these products, 7.41% did so more than twice a week, 17.28% once or twice a week, 29.63% once or twice a month, and 45.68% occasionally. Saving time and convenience were the advantages most widely reported by consumers. A total of 9.9% of respondents did not always respect the "use-by" date of fresh-cut salads, a negative practice that could contribute to the risk of listeriosis. Temperatures reported in domestic refrigerators were compatible with the growth of L. monocytogenes on ready-to-eat salads. Variations in average temperature followed a normal distribution, N(6.62, 2.56), while the variability of temperature variance was described by a gamma distribution, G(2.00, 1.00). As expected, when a time of day-temperature profile was plotted over a 24-h period, changes corresponding to the transition between day and night were observed. Knowledge of consumption patterns and consumer hygiene practices is essential, first in assessing the risk of listeriosis (risk assessment) and second in taking measures to manage that risk (risk management).

Spores from mesophilic Bacillus cereus strains germinate better and grow faster in simulated gastro-intestinal conditions than spores from psychrotrophic strains

The species Bacillus cereus, known for its ability to cause food borne disease, consists of a large variety of strains. An important property for discrimination of strains is their growth temperature range. Psychrotrophic strains can grow well at refrigerator temperatures but grow at 37 degrees C with difficulty. Mesophilic strains on the other hand are unable to grow below 10 degrees C, but grow well at 37 degrees C. Spores of six psychrotrophic and six mesophilic strains were investigated for their ability to survive and grow in simulated gastro-intestinal fluids, mimicking the conditions in the gastro-intestinal tract. The germination potential of psychrotrophic and mesophilic spores in simulated intestinal fluid does not differ much. Under conditions simulating the gastro-intestinal passage, 5 out of 6 mesophilic strains showed growth, and only 2 out of 6 psychrotrophic strains. Temperature (37 degrees C) and simulated gastro-intestinal conditions together influenced germination and growth.

Food Safety Guidance for Older Adults

Aging is associated with loss of the physical barriers and immune efficiency that typically control pathogens' access to and multiplication within the body, thus making infection more likely in elderly persons. Chronic diseases and other health factors, such as malnutrition and immobility, may increase susceptibility to and severity of infections, including foodborne illnesses, in elderly persons, as well as associated morbidity and mortality. Prevention is the best way to avoid foodborne illnesses, but older adults have long-established food preparation and handling practices, some of which may increase the likelihood of illness. Elderly persons rely on physicians as trusted sources of health information. Physicians and other health care professionals can help prevent and control foodborne diseases by educating their patients about the risks of foodborne illness, providing sound advice on safe food-handling and consumption practices, making rapid appropriate diagnoses, and reporting cases promptly to public health authorities.

What does the food handler in the home know about salmonellosis and food safety?

Food-borne illness causes a significant burden of disease globally. The majority of confirmed cases of food-borne illness in Malta are caused by salmonellosis. Detailed case investigations by the Disease Surveillance Unit, Malta, revealed that most of the notified cases of infectious intestinal disease are most likely to be due to poor food safety practices in the home. Consumer awareness studies have shown that, in general, consumers are aware of the recommended food safety precautions, yet still adopt high-risk behaviours. Three focus groups and a small case control group were formed to gather information on local consumer knowledge and attitudes towards safe food handling in the home. The responses from the three focus groups were analysed and grouped into general themes. The information obtained from these results was then used to plan a local food safety health promotion strategy. The results show that individuals who had been exposed to salmonellosis, or who had a dependant who had been exposed, had developed a higher level of food safety knowledge and awareness. Variations between knowledge and self-reported practices make it apparent that persons have to be convinced that food safety measures are effective before they take action to change their behaviour. In conclusion, consumer education strategies need to emphasise the burden of illness, making safe food handling meaningful to consumers. Continuous reinforcement of the messages may be effective in empowering the consumer to foster behaviour change.

Listeria monocytogenes and listeriosis: a review of hazard characterisation for use in microbiological risk assessment of foods

Considerable effort has been put into the application of quantitative microbiological risk assessment for Listeria monocytogenes, and data are available for England and Wales (probably more so than most other countries) on the adverse health effects, together with incidence data on different age and risk groups for human L. monocytogenes infections. This paper reviews aspects of Listeria and human listeriosis, especially from a public health perspective and provide hazard characterisation data, i.e. the qualitative and/or quantitative evaluation of the adverse health effect associated with the hazard, which is the relationship between exposure levels (dose) and frequency of illness. The majority of cases of human listeriosis are food-borne; however, the disease process is complex with multiple routes of infection. The dose-response relationship is poorly understood, and data from human volunteer studies are not available and would be unethical to produce. Data are available from a range of different animal and in vitro models, although these poorly mimic the natural disease process in route of infection, end point, host and history of prior exposure to the bacterium. Epidemiological data provide some information on infective doses and dose responses, but because of the characteristics of the disease (the hugely variable and potentially very long incubation periods, the low attack rates and the rarity of identification of specific food vehicles), this also provides limited data for calculation of dose responses. There is some, albeit limited, evidence for strain variation, but this is an area of considerable uncertainty despite great advances in the genetic basis of the virulence of this bacterium, and almost all strains seem capable of causing serious disease. A variety of mathematical approaches have been used to model dose responses. The review is written to provide a clinical and epidemiological background to the mathematically oriented, as well as to outline the mathematical approaches to those interested in food-borne infection.

Effectiveness of home-based food storage training: a community development approach

A community-based home hygiene training initiative, funded by Merseyside Health Action Zone, was piloted in Dingle, a deprived area of Liverpool, UK, during Spring and early Summer 2000. The project actively involved the community, and home-based domestic hygiene training was delivered by community-based facilitators to households in Dingle, Liverpool. During the project the community-based facilitators visited 904 households on two separate occasions. During the first visit, the community-based facilitators completed a questionnaire and an 'action sheet' which had been designed to measure participants' prior knowledge and behaviour, in relation to a range of important food hygiene issues, and delivered the home-based food hygiene training. Within 8 weeks of the first visit, the community-based facilitators returned to the participating households and completed a second questionnaire and action sheet. Home-based training is effective in raising awareness, and community development approach has the advantage of facilitating access to households which otherwise would have been difficult to reach.

Consumer food handling in the home: a review of food safety studies

Epidemiological data from Europe, North America, Australia, and New Zealand indicate that a substantial proportion of foodborne disease is attributable to improper food preparation practices in consumers' homes. International concern about consumer food safety has prompted considerable research to evaluate domestic food-handling practices. The majority of consumer food safety studies in the last decade have been conducted in the United Kingdom and Northern Ireland (48%) and in the United States (42%). Surveys (questionnaires and interviews), the most frequent means of data collection, were used in 75% of the reviewed studies. Focus groups and observational studies have also been used. One consumer food safety study examined the relationship between pathogenic microbial contamination from raw chicken and observed food-handling behaviors, and the results of this study indicated extensive Campylobacter cross-contamination during food preparation sessions. Limited information about consumers' attitudes and intentions with regard to safe food-handling behaviors has been obtained, although a substantial amount of information about consumer knowledge and self-reported practices is available. Observation studies suggest that substantial numbers of consumers frequently implement unsafe food-handling practices. Knowledge, attitudes, intentions, and self-reported practices did not correspond to observed behaviors, suggesting that observational studies provide a more realistic indication of the food hygiene actions actually used in domestic food preparation. An improvement in consumer food-handling behavior is likely to reduce the risk and incidence of foodborne disease. The need for the development and implementation of food safety education strategies to improve specific food safety behaviors is reviewed in this paper.

Food safety awareness of older people at home: a pilot study

The UK has an increasingly ageing population with the majority of older people preferring to remain independent and live in their own homes. However, during their lifetime, there have been many changes in areas such as food technology and shopping practices which have had a profound influence on the health and well-being of this vulnerable group. The aim of this pilot study, therefore, was to investigate issues surrounding food safety of older people living at home. A focus group (n = 9) was initially conducted to elucidate areas of potential concern. This was followed up by semi-structured interviews and observations (n = 16) within the home. Results show that most participants had not measured their refrigerator temperature and did not know what it should be. The majority had not adjusted the temperature control/dial and gauged the 'correct' temperature by the feel of goods inside. 'Use by' dates were generally well understood, but not always adhered to due to difficulty in reading the labels. Items were purchased near to the end of this date as they are sometimes cheaper, and although older people appreciated these dates related to food safety, items were often kept for up to a month before consumption. This has major implications, particularly if the refrigerator is not working at the correct temperature. There is a lack of readily available educational material on this topic and most people would like to be better informed. If the Government are to encourage more independent lifestyles of older people, then awareness of food safety should be higher on the agenda. Further research to ascertain food safety needs, and awareness of this group are also required. This should also include an assessment of the impact of situations where food consumed at home is prepared elsewhere, e.g. meals-on-wheels.

Consumers and foodborne diseases: knowledge, attitudes and reported behavior in one region of Italy

A survey was conducted to investigate knowledge, attitudes and related behavior on foodborne diseases and food-handling practices among consumers in one region of Italy. A self-administered questionnaire was offered to a random sample of mothers of children attending public schools. Of the 394 responding mothers, 36% knew about all the six foodborne pathogens investigated but only 11.1% correctly indicated six related different food vehicles; education level was a predictor of this knowledge. A positive attitude towards foodborne disease control, significantly higher in older and more educated women, was reported by the great majority, who agreed that improper storage of food represents a health hazard (95.7%), that washing hands before handling unwrapped raw or cooked food reduces the risk of food poisoning (93.2%), and that the awareness of the temperature of the refrigerator is crucial in reducing risk of food poisoning (90.1%). Only 53.9% reported washing hands before and after touching raw or unwrapped food and 50.4% reported using soap to wash hands. A total of 75.6% clean kitchen benches after every use and 81.1% use hot water and soap for this purpose. Only 25.6% thaw food in the refrigerator and 49.9% put leftovers in the refrigerator soon after meals. Washing hands before and after touching unwrapped food was significantly higher in women living in larger families and who had been informed by physicians about foodborne diseases. Educational programs and the counseling efforts of physicians, particularly focused to less educated subjects, are greatly needed.