Methods and measures in food service food safety research: A review of the published literature

Purpose

Food handlers working in food service establishments need to perform appropriate and consistent food safety practices to ensure that the prepared food is safe for consumers to eat, as a failure to do so may lead to foodborne illness. It is important to have an in-depth understanding of food handler food safety behaviour in the food service sector to design targeted educational interventions and approaches to safeguard consumers. The purpose of this review is to provide insight to the existing body of research regarding food handler food safety in the food service sector, and to identify future research needs in terms of methods and measures.

Methods

This study is a review of published food safety research studies (n = 118) focusing on food handlers in the food service sector conducted between 2001 and 2021. Data were collated regarding the methods used and the measures assessed in published studies to identify the gaps in current knowledge related to food safety in food service.

Findings

The majority of studies were conducted in the United States (29%), Brazil (17%) and United Kingdom (7%). A large proportion were carried out in restaurants (70%). Less than a third of studies (28%) relied on a mixed method approach for data collection; and only 12% of studies assessed a combination of cognitive and behavioural measures. Observation was used in only 29% of studies. A lack of observational data detailing food safety practices such as handwashing, temperature control, separation and cleaning was determined.

Significance

Such findings indicate a greater need for mixed method approach in future food safety research. It is recommended that the understanding of food handler food safety performance is best obtained through a combined assessment of cognitive and behavioural measures with subsequent triangulation of findings to reduce bias and to obtain reliable results.

Dietetics Student Perceptions of Food Safety Communication to Vulnerable Populations: An International Study

Registered dietitians can play an important role in delivering food safety information to vulnerable population groups. Although dietetic students are reported to perceive food safety to be important for vulnerable population groups, little is known regarding their attitudes toward their role in the delivery of food safety information. Therefore, the purpose of this study was to determine and evaluate the perceptions of dietetic students regarding their role in food safety communication to vulnerable populations from three international institutions. A total of 208 dietetics students participated in the study from Columbus, Ohio, USA (n = 100), Cardiff, Wales, UK (n = 78), and Beirut, Lebanon (n = 30). Predominantly, the students in this study had positive attitudes toward the importance of food safety for vulnerable groups, although more students from Lebanon were skeptical that vulnerable patients were more susceptible to foodborne infections than the general populations (p < 0.001). Data indicated confidence and understanding of food safety principles and a willingness to learn more about food safety for these groups, however, some students in the UK (30%) and USA (31%) were not confident that they could effectively communicate food safety to vulnerable patients. Based on the findings in this and previous studies, adjustments are recommended to the requirements for food safety knowledge among dietetic students to include food safety counseling competency.

Inclusion of Food Safety Information in Home-delivered U.K. Meal-kit Recipes

Home-delivered meal-kit recipe boxes provide consumers with fresh, measured ingredients requiring storage, preparation, and cooking by following a recipe card.Previous literature has suggested that including food safety information within recipes may positively impact behavior. Therefore, there is a need to better understand what food safety information is included on the meal-kit recipe cards. Content analysis was performed on U.K. meal-kit provider recipe cards (n = 359) obtained using citizen science methods. Although 46% of recipes referred to handwashing at the start of recipe preparation, these stated 'wash hands' with no further advice regarding hand hygiene, and half (48%) did not refer to handwashing during recipe preparation. Most recipes included produce (99%) and referred to washing fruit and vegetables (88%). For meal-kits that provided animal proteins (n = 332), 50% referred to storing ingredients in the fridge, and only one recipe referred to recommended temperatures (≤5°C). Where applicable (n = 346), food safety advice to prevent cross-contamination was present in 51% of recipes.Statements concerning cooking adequacy of animal proteins (n = 1306) included subjective cooking guidance, with 35% referring to visual assessment of color and 26% cooking duration. For best practice food safety guidance, two recipes referred to end-point temperature, and one stated to use a temperature probe. While all meal-kit providers provided some food safety-related information in reviewed recipes, information was often not sufficient to inform consumers about food safety risk-reducing behaviors in the domestic setting. Observational research is needed to understand consumer engagement with how food safety information in meal-kit recipes impacts the behavior of consumers.

A case study of food handler hand hygiene compliance in high-care and high-risk food manufacturing environments using covert-observation

Observation of behaviour is superior to cognitive data, which does not equate to behaviour. Covert-observation is seldom used in food manufacturing to assess behaviour. In this case study, closed-circuit-television footage (15 h) in a business were reviewed to assess hand hygiene compliance using an electronic-checklist. Hand hygiene attempts were observed prior to entering high-risk (cake/pie)(n= 47) and high-care (sandwich/salad)(n= 153) production areas. Business hand hygiene protocol required handwashing durations ≥ 20 s. Observed durations ranged 1-71 s, <96% of attempts were <20 s. Significantly longer durations were observed when food handlers were in the presence of others (12 s) than when alone (9 s). Although <99% utilised soap, only 56-69% wetted hands first. Failure to rub all parts of hands was commonplace (<87%) and 24-35% failed to apply sanitiser after drying. Consequently, >98% of observed attempts before entering production areas did not comply with the protocol. Observed non-compliant practices may have implications for food safety in manufacturing.

Identifying support mechanisms to overcome barriers to food safety scheme certification in the food and drink manufacturing industry in Wales, UK

Obtaining food safety certification is essential for food manufacturers. Potential barriers to obtaining certification are complex, interrelated and broadly relate to, 'knowledge and skills', 'time, cost and resources', and 'communication and access to information'. This study aimed to explore requirements for support to enable food manufacturers in Wales to overcome identified barriers. Food manufacturers (n = 37) participated in group discussions (n = 2) and completed online-questionnaires (n = 29). Support mechanisms, perceived necessary to obtain food safety certification included; funding for training and audit-fees, support for implementing food safety scheme documentation, on-site support through mentoring/coaching and pre-audits. Findings identify the need for a food safety scheme certification support package pathway incorporating online, off-site, on-site and financial support to assist food and drink manufacturers obtain third-party food safety certification. Such assistance would support three critical areas. Findings may inform development of support mechanisms to increase uptake of food safety certification and accelerate food-sector growth.

Assessing Existing Food Safety Resources with United Kingdom-Based Chemotherapy Patients and Family Caregivers for Future Learning Purposes

ABSTRACT

Because the incidence of foodborne infection is more prevalent among cancer patients and the domestic kitchen is a contributor to foodborne infection, appropriate domestic food safety practices are needed to safeguard this at-risk population. Although patients are aware of the increased risk of infection, previous self-reported data indicate potential food safety malpractices among patients and family caregivers, thus suggesting the need for targeted food safety information. However, existing United Kingdom resources provide inconsistent and insufficient food safety information. Involvement of intended end users in the cocreation of interventions increases potential effectiveness. Qualitative data were collated from in-depth interviews and a focus group with United Kingdom chemotherapy patients and family caregivers (n = 35) to determine perceptions and preferences for food safety information by evaluating existing food safety resources from international providers (n = 12). Although participants liked digital interventions (e.g., Web sites and videos), traditional paper-based leaflets were perceived as the most beneficial because they could be referred to on repeated occasions. Despite the drawbacks associated with some resources, combining approaches in a multiresource intervention was favored by patients and family caregivers. Ensuring patients are not overwhelmed with excessive information was important. Short, logical, engaging, educational, and entertaining information to evoke an interest in the topic was preferred. Utilization of graphics to supplement descriptive information may enhance comprehensibility. Interventions need to be appropriate for patients and caregivers, and delivery by trusted health care professionals may enhance the credibility of the message. Preferred approaches to facilitate targeted food safety communication were identified, and these findings can be utilized to cocreate targeted food safety interventions for chemotherapy patients and family caregivers.

HIGHLIGHTS

Raw Meat-Based Pet Feeding and Food Safety: Netnography Study of Pet Owner Comments and Review of Manufacturers' Information Provision

ABSTRACT

Feeding raw meat to domestic pets is a popular practice. Because of the potential food safety implications associated with handling raw meat, concerns about pet owner health have increased. For this study, a netnographic content analysis approach was used to analyze posts from Pet Forums Community online archives related to raw meat-based feeding and food safety (n = 308). United Kingdom manufacturer and supplier Web sites (n = 33) were reviewed for provision of food safety information related to raw meat-based pet feeding. The data were analyzed using a qualitative thematic approach and quantitative methods. Pet owner forum comments indicated potential malpractices and indifference toward possible food safety hazards when preparing raw meat-based pet food. Many were risk aware but indicated confusion regarding appropriate food safety practices. Although emotional concern about the safety of pets and children was expressed, contracting a foodborne disease was not perceived as a personal risk. In addition, the review identified that most (61%) manufacturer and supplier Web sites failed to provide food safety instructions or warnings to pet owners regarding raw meat-based pet food. Information was inconsistent and varied across sources. The most comprehensive sources of information were provided by manufacturers approved by the United Kingdom Pet Food Manufacturers' Association. This is the first netnography study to explore pet owner online reports and the provision of food safety information related to raw pet feeding. Findings suggest pet owners may not fully appreciate the potential risks associated with raw meat-based pet feeding. Consequently, there is a need for credible and consistent strategies to inform pet owners about potential implications associated with feeding raw meat to pets, as well as about safe food handling practices.

HIGHLIGHTS

Awareness and Attitudes of Student Dietitians in Lebanon, UK and USA towards Food Safety

Allied health professionals such as dietitians can play a critical role in providing food safety advice to vulnerable consumers. To maximize food-related health and wellbeing, food needs to be safe and nutritious; consequently, food safety is referred to in international curricula for the training of dietitians. The purpose of this study was to explore the awareness and attitudes of student dietitians from three international institutions towards food safety. A total of 207 student dietitians participated in the study from Columbus, OH, USA (n = 99), Cardiff, Wales, UK (n = 78) and Beirut, Lebanon (n = 30). Completion of the study established that the students in three dietetic training programs lacked awareness of key food safety concepts. Close to half (43%) were not familiar with Campylobacter, with the USA students being significantly less knowledgeable (p < 0.001) with 58% being unaware of the pathogen. Understanding of safe handling of leftovers was the lowest for the students in all institutions; only 46% described appropriate reheating practices, with significantly lower (p < 0.001) understanding in Lebanon (28%). The students reported a good understanding of vulnerable populations and perceived food safety to be important for these groups. However, the knowledge of certain high-risk foods was lacking. For instance, 69% of students thought that fresh squeezed juices and smoothies made with raw fruits and vegetables were safe for vulnerable patients, with the UK students being the least familiar with this risk (16%). This is the first study of its kind to take an international perspective of student dietitian food safety awareness and attitudes; the findings are important to dietetic food safety educators and recommendations are made to further explore the interpretation of food safety requirements in international dietetic curricula. Future studies should extend student dietetic research to address attitudes, self-efficacy and the overall readiness to deliver food safety advice to the patients and the community.

Exploring Food Safety Perceptions and Self-Reported Practices of Pet Owners Providing Raw Meat-Based Diets to Pets

ABSTRACT

The growing popularity of raw meat-based diets for pets is accompanied by increasing concern regarding possible health implications of this practice for pet owners through the storage and preparation of raw meat. This study aimed to explore pet owners' knowledge and perceptions about the safety of raw meat-based feeding and to determine self-reported food safety practices during raw meat-based pet food preparation. An online questionnaire was distributed via social media platforms and completed by pet owners practicing raw meat-based feeding (n = 174). Almost all participants (95%) reported confidence that their pets' raw meat-based food is safe. Two-thirds of respondents (67%) reported that they had researched food safety information regarding raw meat-based feeding, yet only 8% asked a veterinarian for food safety advice. Respondents were aware of pathogens that may be present in raw meat-based diets and of food safety practices; however, they did not report consistent implementation of appropriate food safety practices. Malpractices, such as rinsing of raw meat (27%) and absence of segregation of utensils and kitchen surfaces (52%), were reported. The risk to pet owners of foodborne illness associated with raw meat-based feeding was perceived to be low by 89% of pet owners. Participants perceived low susceptibility to foodborne illness but high self-efficacy, which may be an indication of optimistic bias. This study has identified a need to increase pet owners' awareness of the possible risks to human health associated with raw meat-based feeding of animals. The provision of comprehensive food safety information, intended to target the perceptions of pet owners identified in this study, is needed to improve pet owners' food safety practices and thus to reduce the potential food safety risks associated with raw meat preparation and storage in the domestic environment.

HIGHLIGHTS

Understanding the barriers to food safety scheme certification in the food and drink manufacturing industry in Wales, UK

It is increasingly essential for food manufacturers to have food safety certification. Little is known about certification in the Welsh food industry. This study aimed to explore perceptions of Welsh manufacturers regarding the drivers, benefits and barriers to obtaining certification. Focus groups with manufacturers and stakeholders (n = 68) were conducted. 'Customer requirement' and 'product safety' were drivers for obtaining certification. Benefits related to 'food safety culture', 'supply chain security', 'brand protection', 'due diligence', 'business growth' and 'job security'. Barriers were complex, often interrelated and were broadly defined as, 'knowledge and skills', 'time, cost and resources', and 'communication and access to information'. The research identifies the need to explore requirements for support to enable food manufacturers in Wales to overcome identified barriers. Such data may inform the design and development of support mechanisms to increase uptake of food safety certification and accelerate food sector growth in-line with Welsh Government aspirations.

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.

Domestic Kitchen Microbiological Contamination and Self-Reported Food Hygiene Practices of Older Adult Consumers

Because of increased susceptibility, older adults have an increased risk of foodborne infection, and data suggest elevated incidence; therefore, food hygiene is essential to reduce the risk. Research suggests older adults' inadequate knowledge and negative attitudes toward food hygiene may increase implementation of unsafe food practices. Data on microbiological contamination of domestic kitchens of older adults are lacking. Therefore, this study aimed to determine microbiological contamination of domestic kitchens of older adults. Food contact surfaces and equipment (n = 1,292) in domestic kitchens (n = 100) of older adults (≥60 years) were analyzed to isolate aerobic bacteria, Enterobacteriaceae, Staphylococcus aureus, and Listeria spp.; self-reported hygiene practices were also recorded. Highest contamination levels were determined on in-use cleaning equipment (dish brushes, dishcloths, sponges) with aerobic bacteria <9.3 log CFU per item, Enterobacteriaceae <8.8 log CFU per item, and S. aureus <7.0 log CFU per item. Reported usage length of dish brushes was significantly correlated (P < 0.05) with Enterobacteriaceae contamination. Significant correlations (P < 0.05) were determined between contamination and reported cleaning frequency of refrigerators. Contamination of hand towels in single-occupant households was significantly greater (P < 0.05) than in multioccupant households. The study facilitates novel comparison between reported hygiene practices with microbial contamination, suggesting older adults fail to implement adequate and regular hygiene practices that may increase the possibility of cross-contamination in the domestic kitchen and the associated risk of foodborne illness. Data from this study have determined a need for older adults to improve food hygiene practices in the domestic kitchen.

Food Safety Knowledge and Self-Reported Food-Handling Practices in Cancer Treatment

OBJECTIVES

To explore awareness of foodborne infection risk during chemotherapy treatment, to assess knowledge of risk-reducing food safety practices in patients with cancer and their family caregivers, and to determine self-reported food-handling practices.

SAMPLE & SETTING

A convenience sample of 121 patients receiving chemotherapy and 51 family caregivers of patients receiving chemotherapy in the United Kingdom recruited in the community and using online advertising.

METHODS & VARIABLES

Participants completed a self-report questionnaire to determine food safety knowledge and self-reported food-handling practices.

RESULTS

Although patients receiving chemotherapy and family caregivers reported awareness of food safety practices, self-reported practices indicated that potentially unsafe practices may be used in relation to temperature control, handwashing, safe cooking, and adherence to use-by dates. Such practices may increase the risk of foodborne illness to patients receiving chemotherapy treatment.

IMPLICATIONS FOR NURSING

Nursing research is required to explore the food safety training and awareness of healthcare providers. Highly focused and specifically targeted food safety interventions need to be developed and delivered to increase awareness and to implement food safety practices.

Older Adult Consumers' Attitudes and Perceptions of Risk, Control, and Responsibility for Food Safety in the Domestic Kitchen

Although vast amounts of consumer food safety knowledge and self-reported data exist, attitudinal data detailing perceptions of risk, control, and responsibility are lacking. Such data relating to vulnerable groups, including older adults, are particularly scarce. Perception determination is essential in consumer food safety research to facilitate a comprehensive understanding of the cognitive factors that may impact behavior. Previous research has indicated a relationship between food safety perceptions and behavior. Perceptual data can inform the development of targeted food safety educational interventions. This study was conducted to ascertain older adult consumers' cognitive perceptions regarding food safety. Older adults (≥60 years, n = 100) participated in a computer-assisted personal interview to determine perceived risk, control, and responsibility associated with food safety. Although the potential severity of foodborne illness may be understood, the association between foodborne illness and domestic food preparation may be underestimated. Significant differences were found between perceived personal risk, control, and responsibility and the risks, control, and responsibilities of others ( P > 0.001). Older adults perceived themselves to have lower levels of risk than other individuals have, suggesting perceptions of optimistic bias and personal invulnerability. Perceived greater levels of personal control and responsibility, compared with those of others, suggest perceptions associated with the illusion of control. Correlations were evaluated between personal perceptions of risk, control, and responsibility ( P < 0.05). Low levels of risk were correlated with high levels of control. Those respondents ≥80 years of age perceived higher levels of risk and lower levels of control and responsibility. Cumulatively, older adult consumers expressed perceptions of invulnerability, optimistic bias, and the illusion of control regarding food safety. Such perceptions may undermine attempts to provide education regarding food safety. Food safety messages for this audience must be tailored to overcome such perceptions.

Behavioral Observation and Microbiological Analysis of Older Adult Consumers' Cross-Contamination Practices in a Model Domestic Kitchen

The incidence of foodborne illness is higher in older adults because of their increased susceptibility; therefore, food safety practices are important. However, inadequate knowledge and negative attitudes toward food safety have been reported, which may increase use of unsafe food handling practices. Data on the actual food safety behaviors of older adults are lacking. In this study, food safety practices of older adults were observed and linked to microbiological analysis of kitchen surfaces to identify suspected routes of contamination. Older adults (≥60 years, n = 100) prepared a set meal in a model domestic kitchen sanitized according to a validated protocol to ensure minimal and consistent microbiological loads. Food safety behaviors were observed using ceiling-mounted cameras and recorded using a predetermined behavioral checklist. Surface microbiological contamination also was determined after food preparation. Overall, older adults frequently implemented unsafe food handling practices; 90% failed to implement adequate hand decontamination immediately after handling raw chicken. For older adults who used a larger number of adequate hand decontamination attempts, microbiological contamination levels in the kitchen following the food preparation session were significantly lower ( P < 0.001). The novel utilization of behavioral observation in conjunction with microbiological analysis facilitated identification of potentially unsafe food handling practices as suspected routes of microbiological cross-contamination in a model domestic kitchen. Findings indicate the potential impact on domestic food safety of unsafe food handling practices used by older adult consumers. This innovative approach revealed that a large proportion of older adults implement behaviors resulting in microbiological cross-contamination that may increase the risk of foodborne illness in the home.

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 is 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 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.

Time-Temperature Profiling of United Kingdom Consumers' Domestic Refrigerators

Increased consumer demand for convenience and ready-to-eat food, along with changes to consumer food purchase and storage practices, have resulted in an increased reliance on refrigeration to maximize food safety. Previous research suggests that many domestic refrigerators operate at temperatures exceeding recommendations; however, the results of several studies were determined by means of one temperature data point, which, given temperature fluctuation, may not be a true indicator of actual continual operating temperatures. Data detailing actual operating temperatures and the effects of consumer practices on temperatures are limited. This study has collated the time-temperature profiles of domestic refrigerators in consumer kitchens (n = 43) over 6.5 days with concurrent self-reported refrigerator usage. Overall, the findings established a significant difference (P < 0.05) between one-off temperature (the recording of one temperature data point) and mean operating temperature. No refrigerator operated at ≤5.0°C for the entire duration of the study. Mean temperatures exceeding 5.0°C were recorded in the majority (91%) of refrigerators. No significant associations or differences were determined for temperature profiles and demographics, including household size, or refrigerator characteristics (age, type, loading, and location). A positive correlation (P < 0.05) between room temperature and refrigerator temperature was determined. Reported door opening frequency correlated with temperature fluctuation (P < 0.05). Thermometer usage was determined to be infrequent. Cumulatively, research findings have established that the majority of domestic refrigerators in consumer homes operate at potentially unsafe temperatures and that this is influenced by consumer usage. The findings from this study may be utilized to inform the development of shelf-life testing based on realistic domestic storage conditions. Furthermore, the data can inform the development of future educational interventions to increase safe domestic refrigeration practices.

Older Adult Consumer Knowledge, Attitudes, and Self-Reported Storage Practices of Ready-to-Eat Food Products and Risks Associated with Listeriosis

Consumer implementation of recommended food safety practices, specifically relating to time and temperature control of ready-to-eat (RTE) food products associated with listeriosis are crucial. This is particularly the case for at-risk consumers such as older adults, given the increased listeriosis incidence reported internationally among adults aged ≥60 years. However, data detailing older adults' cognitive risk factors associated with listeriosis are lacking. Combining data about knowledge, self-reported practices, and attitudes can achieve a cumulative multilayered in-depth understanding of consumer food safety behavior and cognition. This study aims to ascertain older adults' cognition and behavior in relation to domestic food handling and storage practices that may increase the risks associated with L. monocytogenes. Older adults (≥60 years) (n = 100) participated in an interview and questionnaire to determine knowledge, self-reported practices, and attitudes toward recommended practices. Although the majority (79%) had positive attitudes toward refrigeration, 84% were unaware of recommended temperatures (5°C) and 65% self-reported "never" checking their refrigerator temperature. Although most (72%) knew that "use-by" dates indicate food safety and 62% reported "always" taking note, neutral attitudes were held, with 67% believing it was safe to eat food beyond use-by dates and 57% reporting doing so. Attitudes toward consuming foods within the recommended 2 days of opening were neutral, with 55% aware of recommendations and , 84% reporting that they consume RTE foods beyond recommendations. Although knowledgeable of some key practices, older adults self-reported potentially unsafe practices when storing RTE foods at home, which may increase risks associated with L. monocytogenes. This study has determined that older adults' food safety cognition may affect their behaviors; understanding consumer food safety cognition is essential for developing targeted food safety education.

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.

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.

Regulatory forum commentary: is unexpected immunostimulation manageable in pharmaceutical development?

One of the biggest challenges in drug development is interpretation of findings suggestive of immunostimulation, particularly when the findings are unexpected based on the known mechanism of action of the drug. Findings suggestive of immunostimulation do not necessarily preclude development of the drug. By understanding mechanism, the patient population, and species differences and by careful clinical monitoring, many of the drugs that produce immunostimulation can be successfully developed. This opinion piece describes various types of immunostimulation and a risk assessment strategy for management of unexpected immunostimulation in toxicity studies.

Development of immunotoxicity testing strategies for immunomodulatory drugs

The ICH S8 immunotoxicity testing guideline for human pharmaceuticals was published in 2006 and was intended to provide guidance for assessing the immunotoxicity potential of low-molecular-weight drugs that are not intended to alter the immune system. For drugs intended to modulate the immune system, immunotoxicity testing strategies are generally developed on a case-by-case approach since the targets, intended patient population, and mechanisms of action of the test compound will determine the type of testing needed. Some of the general principles of ICH S8, however, may be applied to immunotoxicity testing strategies for immunomodulatory drugs. A weight-of-evidence approach using factors discussed in ICH S8 in concert with an assessment of the potential value of additional immunotoxicity testing should be considered. For most situations, immunotoxicity studies with immunomodulatory compounds evaluate off-target effects on the immune system and exaggerated pharmacology. The potential use of data from these studies and considerations such as translatability to humans are discussed.

Naturally occurring infections in non-human primates (NHP) and immunotoxicity implications: discussion sessions

Non-human primates (NHP) are used to best understand and address pharmacology and toxicology obligations for human patients with highest and/or unmet need. In order to ensure the most appropriate care and use of NHP, it is important to understand the normal micro flora and fauna of NHP and ensure their utmost health to generate the most valuable and applicable data. There are many infections, including viral, bacterial, parasitic, and fungal that may perturb physiologic endpoints relevant to human health, and are essential to monitor and/or eradicate for NHP health. This publication captures a discussion involving the experience, knowledge and opinion from academic, industry and government experts regarding emerging and normal infections in NHP as they relate to immunotoxicity, and treatment and consequences of known infections.

Reproductive responses of invasive and native predatory lady beetles (Coleoptera: Coccinellidae) to varying prey availability

As adults, many predatory insects must adjust to a constantly changing prey environment while balancing between survival and reproduction. Two laboratory experiments were conducted to compare reproductive responses of females of two species of lady beetles, invasive Coccinella septempunctata L. and native C. transversoguttata richardsoni (Brown), in Utah alfalfa fields to varying availability of prey. When both lady beetles were placed immediately on experimental diets after being collected from the field (first experiment) and when they were provided excess prey for 14 d before being placed on experimental diets (second experiment), C. septempunctata produced more but individually smaller eggs than C. transversoguttata. Overall, however, in both experiments, C. septempunctata and C. transversoguttata responded similarly when they consumed pea aphids in varying amounts, by laying fewer and less viable eggs when fewer prey were consumed. In particular, the experiments provided no evidence that C. septempunctata converts pea aphids into eggs at a relatively higher rate than C. transversoguttata under limited prey availability. However, C. septempunctata had greater ability than C. transversoguttata to maintain body weight, even as they were producing eggs at low rates. This suggests that low aphid availability is less stressful for C. septempunctata, perhaps because it has more physiological ability than C. transversoguttata to assimilate pea aphid nutrients at low aphid availability. Such ability might contribute to the numerical dominance of the introduced C. septempunctata in alfalfa fields, which have supported low numbers of aphids in recent years.

Testing association between LRRK2 and Parkinson's disease and investigating linkage disequilibrium

BACKGROUND

We and others recently identified the gene underlying PARK8 linked Parkinson's disease (PD). This gene, LRRK2, contains mutations that cause an autosomal dominant PD, including a mutation, G2019S, which is the most common PD causing mutation identified to date. Common genetic variability in genes that contain PD causing mutations has previously been implicated as a risk factor for typical sporadic disease.

METHODS

We undertook a case-control association analysis of LRRK2 in two independent European PD cohorts using 31 tagging single nucleotide polymorphisms (tSNPs) and five potentially functional SNPs. To assess the structure of this locus in different populations, we have performed linkage disequilibrium (LD) analysis using these variants in a human diversity panel.

RESULTS

We show that common genetic variability in LRRK2 is not associated with risk for PD in the European populations studied here. We also show inter-population variability in the strength of LD across this locus.

CONCLUSIONS

To our knowledge this is the first comprehensive analysis of common variability within LRRK2 as a risk factor for PD.

SNCA multiplication is not a common cause of Parkinson disease or dementia with Lewy bodies

The authors recently have shown that triplication of the alpha-synuclein gene (SNCA) can cause Parkinson disease (PD) and diffuse Lewy body disease within the same kindred. The authors assessed 101 familial PD probands, 325 sporadic PD cases, 65 patients with dementia with Lewy bodies, and 366 neurologically normal control subjects for SNCA multiplication. The authors did not identify any subjects with multiplication of SNCA and conclude this mutation is a rare cause of disease.

The toxicity of SCH 351591, a novel phosphodiesterase-4 inhibitor, in Cynomolgus monkeys

SCH351591, a novel phosphodiesterase-4 inhibitor under investigation as a potential therapeutic for asthma and chronic obstructive pulmonary disease (COPD), was evaluated in a 3-month rising-dose study in Cynomolgus monkeys. Four groups, containing four monkeys/sex, received vehicle control or rising doses up to 12, 24, or 48 mg/kg of SCH351591 daily. Although initial exposure produced clinical signs of emesis, reduced food intake, and reduced body weight, tachyphylaxis to the emesis allowed dose escalation up to 48 mg/kg/day. Two monkeys died and 3 were sacrificed in moribund condition over the course of the study. Early mortality, involving monkeys dosed with 12 or 24 mg/kg, was attributed to sepsis (2 monkeys) or colon inflammation (3 monkeys). Leukocyte function assays on low- and mid-dose group survivors revealed an inhibition of T lymphocyte proliferation for 12 mg/kg group males and 24 mg/kg group monkeys of both sexes. Necropsy findings, unassociated with early mortality, included reduced size and weight of the thymus, depletion of body fat, red discoloration of the gastric mucosa, and perivascular hemorrhage of the stomach and heart. Stomach and heart gross findings were present in the high-dose group only. Histopathologic lesions, in addition to those attributed to concurrent bacterial infection, included thymic atrophy, serous atrophy of fat, myocardial degeneration and acute to chronic inflammation of small to medium-sized arteries in various organs and tissues including the heart, kidneys, stomach, salivary glands, pancreas, esophagus, gallbladder, and mesentery. The findings of this study demonstrate the potential of a PDE4 inhibitor to alter immunologic response as well as to produce arteriopathy in nonhuman primates.

A review of antimicrobial peptides: defensins and related cationic peptides

Cationic antimicrobial peptides are present throughout the plant and animal kingdoms and bear striking structural and functional similarities across species lines. They provide primitive, nonspecific means of combating a variety of bacteria, fungi, enveloped viruses, and protozoa. Some are also cytotoxic against host cells, including neoplastic cells. Cationic antimicrobial peptides may play various roles in inflammation and tissue repair. Antimicrobial peptides are found in epithelial tissues regularly exposed to microbial attack as well as in cells whose primary function is defense against potential pathogens. They constitute an important part of the nonoxidative antimicrobial arsenal of leukocytes. They are preformed and/or readily synthesized when the cells are stimulated by exposure to pathogens. They exert their effects directly by inserting into membranes of target cells and forming ion channels which increase membrane permeability; however, antimicrobial peptides can also act as opsonins to facilitate phagocytosis. Resistance to defensins is a virulence factor for organisms such as Salmonella sp. The study of cationic antimicrobial peptides is increasing our understanding of innate immunity, inflammation, and the pathogenesis of genetic diseases such as specific granule disease in humans. Therapeutic applications of antimicrobial peptides are currently under investigation.

Toxicity and carcinogenicity studies of chlorpromazine hydrochloride and p-cresidine in the p53 heterozygous mouse model

The carcinogenic potential of chlorpromazine hydrochloride, a psychotropic agent, was assessed in the p53 heterozygous mouse assay. In a 4-week dose range finding study in p53 wild-type mice, doses of 20,40, 60, and 80 mg/kg were poorly tolerated because of mortality secondary to the severe sedative and hypotensive effects of chlorpromazine. Based on 40% mortality at a dose of 20 mg/kg in the dose-range finding study, a high dose of 10 mg/kg was chosen for the 26-week carcinogenicity study in p53 heterozygous mice. Doses of 2.5, 5, and 10 mg/kg chlorpromazine hydrochloride were well tolerated in the 26-week study. The administration of chlorpromazine hydrochloride at dose levels up to and including 10 mg/kg to p53 heterozygous and wild-type mice did not result in a dose-related increase in tumor incidence or in the type of tumors seen in comparison to controls. Findings related to the administration of chlorpromazine in the 26-week study were limited to minimal uterine and ovarian atrophy in p53 wild-type mice dosed with 10 mg/kg chlorpromazine hydrochloride. However, p53 heterozygous mice administered 400 mg/kg p-cresidine, a genotoxic carcinogen commonly used as a positive control for this model, developed urinary bladder tumors. Administration of p-cresidine also resulted in a regenerative anemia, splenic and hepatic hemosiderosis, renal findings, and ovarian and uterine atrophy. This study demonstrated that chlorpromazine hydrochloride, at the doses tolerated, was not carcinogenic in the p53 heterozygous mouse assay.

Ubiquitous transgenic expression of the IL-23 subunit p19 induces multiorgan inflammation, runting, infertility, and premature death

p19, a molecule structurally related to IL-6, G-CSF, and the p35 subunit of IL-12, is a subunit of the recently discovered cytokine IL-23. Here we show that expression of p19 in multiple tissues of transgenic mice induced a striking phenotype characterized by runting, systemic inflammation, infertility, and death before 3 mo of age. Founder animals had infiltrates of lymphocytes and macrophages in skin, lung, liver, pancreas, and the digestive tract and were anemic. The serum concentrations of the proinflammatory cytokines TNF-alpha and IL-1 were elevated, and the number of circulating neutrophils was increased. In addition, ubiquitous expression of p19 resulted in constitutive expression of acute phase proteins in the liver. Surprisingly, liver-specific expression of p19 failed to reproduce any of these abnormalities, suggesting specific requirements for production of biologically active p19. Bone marrow transfer experiments showed that expression of p19 by hemopoietic cells alone recapitulated the phenotype induced by its widespread expression, pointing to hemopoietic cells as the source of biologically active p19. These findings indicate that p19 shares biological properties with IL-6, IL-12, and G-CSF and that cell-specific expression is required for its biological activity.

Renal changes associated with naproxen sodium administration in cynomolgus monkeys

Naproxen sodium was administered to cynomolgus monkeys (Macaca fascicularis) by oral gavage at daily doses of 44, 88, or 176 mg/kg for 2 wk (2 monkeys/gender) or of 44 mg/kg for 13 wk (4 monkeys/gender). Body weight loss occurred in at least one monkey in all naproxen sodium-dosed groups in the 2-wk (up to 16% loss) and 13-wk (up to 22% loss) studies. Increases in plasma naproxen concentrations were dose proportional between 44 and 88 mg/kg but were less than dose proportional between 88 and 176 mg/kg. Up to 2-fold increases in creatinine and/or serum urea nitrogen values as well as higher renal weights occurred in monkeys receiving 176 mg/kg for 2 wk or 44 mg/kg for 13 wk. Microscopically, renal changes were observed in all naproxen sodium-dosed groups. Renal findings after 2 wk of exposure included increased interstitial ground substance, tubular dilatation, and tubulointerstitial nephritis; in the 13-wk study, cortical tubular atrophy and interstitial fibrosis were also observed. These studies identify the kidney as the target organ of naproxen sodium in cynomolgus monkeys.

Antimicrobial activity of chicken and turkey heterophil peptides CHP1, CHP2, THP1, and THP3

Four avian heterophil antimicrobial cationic peptides (Chicken Heterophil Peptides 1 and 2, and Turkey Heterophil Peptides 1 and 3) were evaluated for in vitro microbicidal activity against selected avian pathogens and human pathogens which are harbored by birds. At concentrations of 16-2 micrograms/ml, all four avian peptides effected a greater than 90% reduction in the survival of Candida albicans, Salmonella enteriditis, and Campylobacter jejuni. None of the peptides, including the known antimicrobial peptide protamine (used as a positive control), were able to reduce the survival of Pasteurella multocida by 90% at the maximum peptide concentration (16 micrograms/ml) tested. At 16 micrograms/ml, the turkey peptide THP3 did not effect a 90% reduction in survival of Bordetella avium, Escherichia coli, or Salmonella typhimurium, while all of the other peptides tested were effective at this concentration or less. This peptide, THP3, does not share the same homologous amino acid sequence shared by the other three peptides. Under our experimental conditions, none of the peptides neutralized Infectious Bronchitis Virus, an enveloped coronavirus of chickens.

Isolation of antimicrobial peptides from avian heterophils

Five bactericidal peptides (chicken heterophil peptides CHP1 and CHP2; turkey heterophil peptides THP1, THP2, and THP3) were purified from avian heterophil granules. All peptides were cationic and rich in cysteine, arginine, and lysine. The complete amino acid sequence, consisting of 39 amino acids, was determined for CHP1. This peptide had a molecular weight of 4481 as determined by mass spectrometry. Partial NH2-terminal amino acid sequences were obtained for the remaining peptides. Both chicken peptides and THP1 shared sequence homology at 22 residues and a cysteine motif which was similar to that of bovine beta-defensins. THP2 and THP3 were homologous to each other but were not homologous to the other three and had a unique cysteine motif. Peptides CHP1, CHP2, and THP1 killed Staphylococcus aureus and Escherichia coli in vitro, whereas THP2 and THP3 killed only S. aureus in vitro.

A study of the effect of exposure in the reticulo-rumen of the cow on the strength of cotton, grass, hay and straw

1. Changes in strength of cotton, Italian ryegrass leaf, hay stem and barley-straw stem on immersion in the contents of the reticulo-rumen, at two sites in the rumen and at one site in the reticulum, for periods of up to 56 h were measured using a cow on a hay diet. Specimens of the fibrous materials were immersed in the rumen digesta in such a way that they were not damaged by agitation or by rumination.

2. Load-to-fracture and elongation were measured on a machine using a constant-speed cross-head at a strain of about 10−3/s. The ratio strength:density (breaking load/mass per unit length) was determined.

3. Leaf of Italian ryegrass and stem of hay and of barley straw had strengths of about 37, 150 and 210 MN/m2. They lost strength at different rates when immersed in the rumen digesta, the times to half strength being in the ratio grass: hay: straw = 1:1.9:3.8. The similarity of this ratio to that for total time for eating and ruminating as given by Balch (1969), namely 1:2.0:3.5, for similar materials was noted.

Changes in some physical characteristics of the digesta in the reticulo-rumen of cows fed once daily

1. Three cows were given 3, 5 or 7 kg hay once daily in a Latin-square design, and samples of digesta from four sites in the rumen and one site in the reticulum were taken at six times within the 24 h period after the feed. Dry-matter content and distribution of particle size and of particle density were measured for each sample. The changes in these measurements with time were studied. The incidence of rumination was also recorded.

2. Dry-matter contents of samples ranged from 15 to 3%. Values for samples from the dorsal sacs of the rumen were considerably higher than those for samples from the ventral sites; they also changed more with time after feeding and with level of feeding.

3. Particles were fractionated by sieving into six size groups with mean dimensions (mm) of 9·3 × 0·8, 4·4 × 0·6, 2·6 × 0·3, 1·6 × 0·25, 0·5 × 0·1 and smaller than 0·5 × 0·1. Coarse particles occurred at highest concentrations in the dorsal sacs of the rumen and responded to effects of time and level of feeding; smaller particles showed less response.

4. Particle densities ranged from 800 g/l to 1500 g/l. The proportions of low-density particles were higher in samples from the dorsal sacs of the rumen than in samples from ventral sites; the latter samples had higher proportions of high-density particles than of low-density particles. The changes which occurred are discussed.

5. The density of coarse particles tended to be low and that of fine particles tended to be high.

6. Rumination started at the time of maximum concentration of particles of low density and minimum concentration of particles of high density. Conversely, rumination ended when the concentration of the low-density particles was a minimum and that of the dense particles a maximum.

7. The results are discussed in relation to the possible movement of particles within the reticulo-rumen and the kinetics of particle breakdown.

Resection for bronchial carcinoma in the elderly

The results of surgery for carcinoma of the bronchus among an elderly population are reviewed in relation to the total number of cases seen. Although there is a 20% operative hospital mortality, nevertheless a survival rate of 39% for four years makes surgery in the elderly worthwhile. The span of life in untreated cases is even less than in the younger age groups.