Causes and consequences of hyperhomocyst(e)inemia

CONTEXT: This large outbreak of foodborne disease highlights the challenge of investigating outbreaks caused by intentional contamination and demonstrates the vulnerability of self-service foods to intentional contamination. OBJECTIVE: To investigate a large community outbreak of Salmonella Typhimurium infections. DESIGN: Epidemiologic investigation of patients with Salmonella gastroenteritis and possible exposures in The Dalles, Oregon. Cohort and case-control investigations were conducted among groups of restaurant patrons and employees to identify exposures associated with illness. SETTING: A community in Oregon. Outbreak period was September and October 1984. PATIENTS: A total of 751 persons with Salmonella gastroenteritis associated with eating or working at area restaurants. Most patients were identified through passive surveillance; active surveillance was conducted for selected groups. A case was defined either by clinical criteria or by a stool culture yielding S Typhimurium. RESULTS: The outbreak occurred in 2 waves, September 9 through 18 and September 19 through October 10. Most cases were associated with 10 restaurants, and epidemiologic studies of customers at 4 restaurants and of employees at all 10 restaurants implicated eating from salad bars as the major risk factor for infection. Eight (80%) of 10 affected restaurants compared with only 3 (11%) of the 28 other restaurants in The Dalles operated salad bars (relative risk, 7.5; 95% confidence interval, 2.4-22.7; P<.001). The implicated food items on the salad bars differed from one restaurant to another. The investigation did not identify any water supply, food item, supplier, or distributor common to all affected restaurants, nor were employees exposed to any single common source. In some instances, infected employees may have contributed to the spread of illness by inadvertently contaminating foods. However, no evidence was found linking ill employees to initiation of the outbreak. Errors in food rotation and inadequate refrigeration on ice-chilled salad bars may have facilitated growth of the S Typhimurium but could not have caused the outbreak. A subsequent criminal investigation revealed that members of a religious commune had deliberately contaminated the salad bars. An S Typhimurium strain found in a laboratory at the commune was indistinguishable from the outbreak strain. CONCLUSIONS: This outbreak of salmonellosis was caused by intentional contamination of restaurant salad bars by members of a religious commune.     

Preventive oral health behaviors in a multi-cultural population: the North York Oral Health Promotion Survey

To examine the preventive oral health behavior levels of randomly-selected dentate and edentulous adults, age 18 and over, a mail survey was conducted in North York, Ontario, a multicultural suburb of Metropolitan Toronto (n = 1,050). High optimal levels of at least daily tooth brushing were reported by the majority of the dentate (96 per cent). Lower rates were evident for yearly preventive visiting (69 per cent), daily flossing (22 per cent), daily use of an interdental device (25 per cent), not snacking between meals (12 per cent) and eating one or no cariogenic foods on the previous day (36 per cent). Logistic regression results indicated higher levels on an additive index of oral preventive behaviors for females, those having a higher education and non-Italian respondents. Edentulous respondents reported high daily denture cleaning rates (87 per cent), but less frequent night removal (51 per cent), checking for oral lesions (68 per cent) and preventive visiting (12 per cent). Oral disease is one of the most common and costly chronic disorders affecting modern populations. However, unlike most other chronic diseases, it is largely preventable. These data indicate a clear need for determined oral health promotion efforts to inform and encourage increased levels of preventive behaviors in addition to tooth and denture brushing, particularly among specific sociodemographic and ethnic groups.     

Prospective investigation of cryptic outbreaks of Salmonella agona salmonellosis

The number of Salmonella agona isolates reported annually in Texas from 1992 through 1994 ranged from 14 to 21. An increase in incidence of S. agona infections was noted in the fall of 1995. Pulsed-field gel electrophoresis (PFGE) analysis identified prospectively two possible cryptic outbreaks caused by an indistinguishable strain which was isolated from 18 of 59 patients who were culture positive from March through December 1995. These 18 patients had onset of illness from 20 May through 3 October 1995. Eight individuals resided in the Austin area, eight resided in San Antonio, and two resided in Houston; none had attended a common social gathering or owned common pets. Six patients in San Antonio and one patient from Houston recalled eating food items from the same Mexican food restaurant in San Antonio. S. agona organisms with the same PFGE profile were isolated from machacado, an air-dried, raw beef product prepared at the restaurant. The machacado had been shredded in a kitchen blender which was the probable source for cross-contamination of other food items. Five patients in Austin reported eating at a popular Mexican food restaurant in Austin. Improperly prepared machacado also may have been served at the Austin restaurant; however, sufficient quantities of machacado were not available for analysis. PFGE was essential in determining whether the cases constituted outbreaks and was invaluable in guiding the epidemiological investigation.     

Food preferences, eating patterns, and physical activity among adolescents: correlates of eating disorders symptoms

PURPOSE: Food preferences, eating patterns, and physical activity patterns were examined in a cohort of adolescent females and males participating in a longitudinal study of the developmental antecedents of eating disorders. METHODS: All adolescents (n = 1494) in grades seven through ten in an entire school district completed a survey about their dieting behaviors, eating, and exercise patterns. RESULTS: Principal components analysis showed similar factor structures for food preferences and eating patterns among males and females. Gender differences were present in physical activity patterns. Sports participation was correlated with healthy food preference and was a significant predictor of eating disorders symptoms. Junk food preference was marginally inversely related to eating disorders symptoms in females. Preference for other types of foods and reported intake of foods were not related to eating disorders symptoms. The percent of variance in risk score accounted for by dietary intake and physical activity patterns was small. CONCLUSIONS: Psychological and social/environmental variables may explain a larger proportion of the variance in eating disorders risk than the dietary and physical activity variables examined in this study. Implications for understanding the etiology and behavioral expression of eating disorders are discussed.     

Individual differences in schema utilization during discourse processing.

Discourse processing involves an interaction of text-based and knowledge-based processes. It was hypothesized that college students (N?=?112) would differ in their relative employment of knowledge-based processes, and that Ss would tend to be more "text bound" when they were more "stimulus bound" in another task with analogous processing demands (i.e., an embedded figures test; EFT). Extent of knowledge-based processing (or schema utilization) was assessed by comparing recall of food items from a narrative about a trip to a fancy restaurant with that from a parallel narrative about a trip to a supermarket. Previous research has demonstrated that since the "foods purchased" component of the restaurant schema is more highly constrained than the equivalent component of the supermarket schema, the former supports greater food item recall. As predicted, food item recall was significantly positively correlated with EFT residuals (after predicting EFT from vocabulary test scores) for the restaurant condition, with no correlation for the supermarket control. Other dependent measures yielded the same pattern of positive correlation with EFT or no correlation with EFT as a function of whether performance would be enhanced by schema utilization or not, respectively. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sensory-specific satiety: comparison of taste and texture effects

The respective contributions of taste (saltiness and sweetness) and texture (the hardness dimension) to sensory-specific satiety (SSS) were compared. Sixteen male and 16 female, young, normal-weight adults rated the pleasantness of taste, pleasantness of texture and desire to eat on visual analog scales for eight test foods, were then given one of the foods to eat ad libitum for lunch, and re-rated the same parameters for the eight foods 2 and 20 min after the end of the meal. The experimental sets of eight test foods and four lunch foods were balanced for taste quality (salty vs. sweet) and texture quality (hard vs. soft). Lunch foods were the hard and soft versions of a salty food (ham and cheese sandwich on baguette vs. white bread) or of a sweet food (apples vs. applesauce). Sensory-specific satiety was observed for both saltiness and sweetness (e.g. pleasantness of the taste of, and desire to eat sweet test foods decreased significantly after eating a sweet lunch food and similarly for salty foods), and to a lesser extent for texture (e.g. pleasantness of the texture of, and desire to eat hard test foods decreased after eating a hard lunch food and similarly for one of the soft foods). The authors conclude texture-specific satiety may be a significant component of satiety.     

Combined dieting and stress evoke exaggerated responses to opioids in binge-eating rats.

The authors developed an animal model of binge eating where history of caloric restriction with footshock stress (R + S) causes rats to consume twice the normal amount of palatable food. The authors tested the hypothesis that binge eating is mediated by changes in opioid control of feeding by comparing rats' anorectic and orexigenic responses to naloxone and butorphanol, respectively, and by testing the ability of butorphanol to elicit binge eating of chow when palatable food was absent. Mu/kappa opioid-receptor blockade and activation had exaggerated responses in the R + S rats with naloxone suppressing binge eating to control levels, and although butorphanol did not trigger chow binge eating, it enhanced binge eating of palatable food. These responses in sated normal-weight rats strengthen evidence that reward, over metabolic need, drives binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Staphylococcal food poisoning caused by imported canned mushrooms

From February through April 1989, four outbreaks of staphylococcal food poisoning in the United States were associated with eating mushrooms canned in the People's Republic of China (PRC). In the four outbreaks, 99 persons who ate at a suspect facility developed gastrointestinal symptoms within 24 h, including 18 who were hospitalized. Illness was associated with eating mushrooms at a university cafeteria (relative risk [RR] = 53.0), a hospital cafeteria (RR = 13.8), a pizzeria (odds ratio [OR] = infinity), and a restaurant (OR = infinity) (all P < .0001). Staphylococcal enterotoxin A was found by ELISA in mushrooms at the sites of two outbreaks and in unopened cans from the three plants thought to have produced mushrooms implicated in outbreaks. These investigations led to multistate recalls and a US Food and Drug Administration order to restrict entry into the United States of all mushrooms produced in the PRC; until this action, the United States imported approximately 50 million pounds yearly.     

Social inequities and food: an ecological study of the food sales of a supermarket chain

With the aim of finding out the pattern of food consumption in different socioeconomic areas of the city of Valencia and examining if the sales data from the supermarkets make up an information source which is capable of detecting inequalities and revealing trends, the sales figures of a chain of supermarkets, referring to 10 food products during 1989 and 1990 were studied. Foods were considered as "healthier" (fruit, vegetables, skimmed milk, fresh fish and chicken), "less healthy" (pork, butter and cakes) and foods indicative of a "new style of eating" (pre-cooked frozen foods and frozen food products). The ratio of between "healthier" food sales and sales of "less healthy" foods is directly related to the socio-economic level of the population. The higher the socioeconomic level, the higher, the ratio of proportions of "healthier" and less healthy" food. This pattern was similar for 1989 (2.78 in lower level districts and 3.32 in higher level districts, and in 1990 (2.92 and 4.09 respectively) (p < 0.01). From these results, we deduce the need for developing different activities for the promotion of healthy foods according to social groups.     

Acute impaction of the rumen in a herd of Friesian cows

An outbreak of acute impaction of the rumen in a herd of Friesian cows associated with the over eating of young grass and exposure to severe weather conditions, is described. The morbidity rate was 100 per cent and the mortality rate 6-5 per cent.     

Comparison of price change and health message interventions in promoting healthy food choices.

This study examines the feasibility and effectiveness of an environmental intervention for improving diet by comparing the impact of health messages, lowered prices, and their combination on the purchase of healthy food items in a restaurant. Price decreases alone, rather than a combination of price decreases and health messages, were associated with a higher level of increased purchases of some healthy food items as compared with control items over a 4-month period. Price decreases may be a more powerful means than health messages of increasing consumption of healthy foods. Health messages may have paradoxical effects if foods labeled as healthy are assumed to taste bad. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of the etiologic structure of urinary tract infection and antibiotic-resistance of its pathogens

The main pathogens of inflammatory diseases of the kidneys and upper urinary tracts in inpatients of an urological unit were gramnegative organisms of the family Enterobacteriaceae while the pathogens of the infection of the lower urinary tracts (nonspecific urethritis) and male genitalia were grampositive cocci. Pseudomonas aeruginosa, Enterobacter agglomerans and Proteus spp. (indole positive) were the chief causative agents of the hospital infections. The analysis of the materials revealed a tendency towards an increase in the microflora resistance to the most widely used antibiotics: aminoglycosides, cephalosporins and fluoroquinolones. This especially applied to the "problem" pathogen P.aeruginosa. Thus, in 1987 the portion of the P.aeruginosa gentamicin susceptible strains amounted to 52 per cent whereas in 1996 it was 13 per cent. The strains susceptible to ofloxacin equaled 79 per cent in 1988 and 44 per cent in 1995. At present the drugs of choice in the treatment of urinary tract infections due to P.aeruginosa are ceftazidime, cefpirome and amikacin (65, 64 and 62 per cent of the susceptible strains respectively). The importance of permanent microbiological monitoring and the respective correction of the therapy are indicated.     

The problem of hidden food allergens: two cases of anaphylaxis to peanut proteins concealed in a pizza sauce

Peanut is one of the major food allergens inducing anaphylaxis. It is increasingly consumed and often used as a hidden ingredient, thus making avoidance especially difficult for allergic patients. In Switzerland legislation stipulates that all ingredients of a processed food exceeding 2% of the total mass of the finished food product should be labelled. However, in the case of a mixture of vegetables it can be labelled as "vegetable mix" if it does not exceed 10% of the total weight. Peanut, which is a member of the legume family, can thus form up to 10% of processed foods without being mentioned on the label, thus making avoidance impossible. We report on two patients who presented severe anaphylaxis from peanut hidden in a pizza from a fast food restaurant. We were able to provide evidence for the presence of major peanut antigens in the pizza sauce by immunochemical analysis. These two cases clearly demonstrate the danger of peanut hidden in foods and point up the necessity of a change in legislation.     

Lack of Interference in Long-Term Memory for Socially Learned Food Preferences in Rats (Rattus norvegicus).

Outside the laboratory, rats (Rattus norvegicus) are likely both to interact with several conspecifics that have eaten various foods and to eat a variety of foods themselves before they encounter any particular food for which they have a socially enhanced preference. Here the authors examine the stability of rats' socially learned food preferences following 6 days of potentially disruptive ingestive experiences. The authors found that 6 days of (a) eating unfamiliar foods, (b) interacting with demonstrators that had eaten unfamiliar foods, or (c) both eating unfamiliar foods and interacting with demonstrators that had eaten those foods had no measurable effect on rats' socially learned food preferences. The stability of socially enhanced food preferences over time and despite potentially disruptive experiences is consistent with the view that social learning about foods is an important determinant of the food choices of free-living Norway rats. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An outbreak of type A botulism associated with a commercial cheese sauce

BACKGROUND: Although botulism is rare, recognition of a possible case of this illness represents a public health emergency. To prevent more cases, prompt investigation must be done to determine whether illness is linked to commercial product or restaurant. Botulism can masquerade as other illnesses, and seemingly unlikely foods can harbor botulinum toxin. OBJECTIVE: To confirm the diagnosis and determine the cause and extent of an outbreak of botulism associated with food served at a delicatessen. DESIGN: Retrospective cohort study of patrons of the delicatessen; laboratory analysis of food, serum samples, and stool samples; and traceback of implicated food. SETTING: Community in Georgia. PARTICIPANTS: Patrons of the delicatessen. MAIN OUTCOME MEASURES: Botulinum toxin in food, serum, or stool and Clostridium botulinum in food and stools. RESULTS: 8 of 52 patrons (15%) met the case definition for botulism. In 4 of the 8 patrons, and illness other than botulism was initially diagnosed. Five of the 8 were hospitalized, and 1 died. Stool cultures from 4 patrons yielded type AC. botulinum, and two serum samples contained botulinum toxin. All ill persons ate food from the delicatessen on 1 October 1993. Of the 22 persons who ate at the delicatessen that day, all 8 ill persons but none of the 14 well persons ate a potato stuffed with meat and cheese sauce. An open can of cheese sauce contained type A botulinum toxin and yielded C botulinum on culture. Cheese sauce experimentally inoculated with C botulinum spores became toxic after 8 days at a temperature of 22 degrees C (room temperature). CONCLUSIONS: A commercial, canned cheese caused a botulism outbreak. This product readily becomes toxic when contaminated by C botulinum spores and left at room temperature. Mild botulism caused by unusual vehicles may be misdiagnosed. Botulism should be included in the differential diagnosis of persons with signs or symptoms of acute cranial nerve dysfunction.     

Acquired aversions as the basis for varied diets of ruminants foraging on rangelands

Ruminants eat an array of plant species that vary in nutrients and toxins. This selection makes intuitive sense, but no theories adequately explain this diversity. Some maintain it reduces the likelihood of overingesting toxins, whereas others contend it meets nutritional needs. Nevertheless, herbivores seek variety even when toxins are not a concern and nutritional needs are met. I offer another explanation for this behavior, one which encompasses the avoidance of toxins and the acquisition of nutrients. A key concept in this theory is aversion, the decrease in preference for food just eaten as a result of sensory input (a food's taste, odor, texture, i.e., its flavor) and postingestive effects (effects of nutrients and toxins on chemo-, osmo-, and mechano-receptors) unique to each food. Aversions are pronounced when foods contain toxins or high levels of rapidly digestible nutrients; they also occur when foods are deficient in specific nutrients. Aversions occur even when animals eat nutritionally adequate foods because satiety (satisfied to the full) and surfeit (filled to nauseating excess) represent points along a continuum, and there is a fine line between satiety and aversion. Thus, eating any food is likely to cause a mild aversion, and eating a food too frequently or in excess is likely to cause a strong aversion. Aversions are involuntary and are not the result of conscious decisions by an animal. Aversions yield benefits (e.g., obtain a balanced diet, reduce ingestion of toxic foods, optimize foraging and rumination times, sample foods, maintain a diverse microflora in the rumen) that are often mistaken as the cause of varied diets. In this article, I discuss the subtle ways in which aversions diminish preference and cause animals to eat a variety of foods.     

Volatile flavor release from foods during eating

Classical analyses for volatile flavors (headspace or distillation/extract methods) give information on either the volatiles present in the air above a food before eating or the total volatile composition of the food. When foods are eaten, however, many changes take place (such as hydration/dilution with saliva, increase in surface area, etc.) that affect the release of volatiles from the food and therefore the profile of volatiles that are sensed in the nose. If we wish to study the relationship between flavor volatiles and the sensory properties of a food, it seems logical to measure the volatile profile that exists during eating. Although volatile flavor release during eating has been measured using a variety of sensory and psychophysiological analyses, only recently have instrumental methods been developed to measure the release of volatile compounds in humans as they eat. Whereas the sensory data give an overall measure of flavor perception, instrumental analyses can potentially follow the release of each and every flavor volatile and thus give a full picture of the aroma profiles generated during eating. From these instrumental measurements, a number of key factors have been identified. First, it has been shown that the volatile profile measured during eating is indeed different from the headspace profile of whole foods. Second, it is clear that the volatile profile in-mouth changes with time as the state of the food changes with chewing. Third, the volatile release from low-water foods is affected by the rate and extent of hydration in-mouth. The ability to measure aroma before, during, and after eating may lead to an understanding of the links between aroma release, interaction of volatiles with aroma sensors in the nose, and the overall perception of food flavor.     

A cluster of Escherichia coli O157:H7 infections with the hemolytic-uremic syndrome and death in California. A mandate for improved surveillance

In mid-January 1993, an outbreak of Escherichia coli O157:H7 infections associated with eating hamburger patties at a fast-food restaurant chain (chain A) was reported in Washington State. From mid-December to mid-January, 9 cases of E coli O157:H7-associated bloody diarrhea and the hemolytic-uremic syndrome had been reported in San Diego County, California. A total of 34 persons had bloody diarrhea, the hemolytic-uremic syndrome, or E coli O157:H7 organisms isolated from stool during the period November 15, 1992, through January 31, 1993. Organisms of E coli O157:H7 identified from 6 persons were indistinguishable from those of the Washington outbreak strain. Illness was associated with eating at chain A restaurants in San Diego (odds ratio, 13; 95% confidence interval, 1.7, 99) and with eating regular-sized hamburgers (odds ratio, undefined; lower-limit 95% confidence interval, 1.3). Improved surveillance by mandating laboratory- and physician-based reporting of cases of E coli O157:H7 infection and the hemolytic-uremic syndrome might have alerted health officials to this outbreak sooner, which could have resulted in earlier investigation and the institution of measures to prevent more cases.