Impact of Training on Employees' Handwashing Behaviors in School Nutrition Programs.

BACKGROUND: School nutrition employee behavior plays an important role in preventing foodborne outbreaks and protecting the almost 30 million children who partake in daily school lunch. OBJECTIVE: The study aim was to compare the impact of using a food safety training program with or without using a realistic-event video on handwashing behavior modification for school nutrition employees. DESIGN: A 2-group (control and experimental) pretest with 2 post-tests design was used. The control group received training without the video and the experimental group received the food safety training with a realistic-event video. Measurements used to address the purpose and objectives of this study included questionnaires and direct observations. PARTICIPANTS/SETTING: The sample consisted of 443 school nutrition employees responsible for food preparation and service affiliated with 21 school districts in 18 states. Approximately half of the sample attended the original unmodified training and the other half attended the modified training. Data were collected in the United States during 2017. A total of 338 employees participated in the observations and 443 participants completed the questionnaires during the 3 phases; 935 questionnaires were used for the analysis. INTERVENTION: The intervention involved a food safety training program embedded with a realistic-event video related to handwashing. The video used previous research to target antecedents to handwashing behavior among participants. MAIN OUTCOME MEASURES: Actual behavior was observed across 3 phases-pretraining, post training, and final-for both the control and experimental groups. In addition, indirect and direct measures of behavioral intentions for handwashing were measured. STATISTICAL ANALYSIS PERFORMED: For the observation data, a 2-way, fixed-effects, mixed-model procedure was used to analyze the data. Simple and multiple linear regression and contingency table analyses looking for differences among phases and treatments were used for questionnaire data analysis. RESULTS: Most practices were reported as in compliance (51.3% to 80.6%) for both the control and experimental groups during all phases. The experimental group had a higher behavioral intention of properly washing their hands than participants in the control group. CONCLUSIONS: The results showed that handwashing practices were in compliance most of the time for both the control and experimental groups during all 3 observation periods. Differences among the data collection periods on the theory of planned behavior constructs indicated no statistical effect of the treatment (exposure to the video) between the control and intervention groups.

A Model for Improving Diet Quality within Child Nutrition Programs: The U.S. Army's Child and Youth Services Healthy Menu Initiative.

The U.S. Army's Child, Youth, and School Services (CYS), which has the capacity to serve more than 70,000 meals/snacks per day, is a geographically dispersed system with facilities worldwide. This case report is a description and evaluation of the implementation of a major food program initiative within the CYS system. In collaboration with Kansas State University, the Healthy Menu Initiative was established to standardize the system's menus, reflect the guidance contained within the 2015-2020 Dietary Guidelines for Americans, and take into account the Child and Adult Care Food Program regulations that went into effect on 1 October 2017. Food storage space, food service equipment, product availability, food safety considerations, and staff shortages have all proven to be challenges in the development and implementation of the menus. Participant acceptance has been an issue in some instances, and special diet requirements add to the workload of the staff. To overcome these challenges, input was solicited from CYS management, care providers, food service staff, and participant families, as well as participants themselves. Taste testing and classroom cooking activities have been developed to increase acceptance, and over 500 CYS food program staff have attended in-depth training sessions to support the initiative. Overall, the initiative has been well received, and there has been an improvement in the diet quality of the foods served within the program. This improvement is noteworthy, as optimal growth and development during childhood and adolescence are reliant on sound nutrition.

The impact of replacing breakfast grains with meat/meat alternatives: an evaluation of child nutrition policy.

OBJECTIVE: To evaluate the Child and Adult Care Food Program (CACFP) rule that allows a meat/meat alternative to replace the breakfast grain requirement three times per week. DESIGN: A 5-week menu including breakfast, lunch and snack was developed with meat/meat alternative replacing the breakfast grain requirement three times per week. Menu nutrients based on the minimum requirements were compared with reference values representing the Acceptable Macronutrient Distribution Range for fat and a range of reference values representing two-thirds the Dietary Reference Intake for 3-year-olds and 4-5-year-olds. The meal pattern minimum requirements were compared with two-thirds of those recommended by the Dietary Guidelines for Americans (DGA). SETTING: Evaluation took place between April and June 2019. PARTICIPANTS: Human subjects were not utilized. RESULTS: The CACFP minimum grain requirement is well below the DGA reference value (0·5-1·5 v. 3·33 ounce-equivalents). Energy (2208·52 kJ) was below the reference values (3126·83-4362·53 kJ). Protein (34·43 g) was above the reference values (9·87-10·81 g). Carbohydrate (76·65 g), fibre (7·46 g) and vitamin E (1·69 mg) were below their reference values of 86·67 g, 10·46-14·60 g and 4-4·76 mg, respectively. Fat (22·57 %) was below the reference range (25-40 %). CONCLUSIONS: The CACFP rule which allows a meat/meat alternative to replace the breakfast grain requirement three times per week may result in meal patterns low in energy, carbohydrate, fat, fibre and vitamin E, while providing an excessive amount of protein.

Varying influences of motivation factors on employees' likelihood to perform safe food handling practices because of demographic differences.

Food safety training has been the primary avenue for ensuring food workers are performing proper food handling practices and thus, serving safe food. Yet, knowledge of safe food handling practices does not necessarily result in actual performance of these practices. This research identified participating food service employees' level of agreement with four factors of motivation (internal motivations, communication, reward-punishment, and resources) and determined if respondents with different demographic characteristics reported different motivating factors. Data were collected from 311 food service employees who did not have any supervisory responsibilities. Intrinsic motivation agreement scores were consistently the highest of all four motivational factors evaluated and did not differ across any of the demographic characteristics considered. In contrast, motivation agreement scores for communication, reward-punishment, and resources did differ based on respondents' gender, age, place of employment, job status, food service experience, completion of food handler course, or possession of a food safety certification. In general, respondents agreed that these motivation factors influenced their likelihood to perform various safe food handling procedures. This research begins to illustrate how employees' demographic characteristics influence their responses to various motivators, helping to clarify the complex situation of ensuring safe food in retail establishments. Future research into why employee willingness to perform varies more for extrinsic motivation than for intrinsic motivation could assist food service managers in structuring employee development programs and the work environment, in a manner that aids in improving external motivation (communication, reward-punishment, and resources) and capitalizing on internal motivation.

[Genetic diseases in pediatric patients hospitalised in the town of Ubaté, Colombia]. / Enfermedades de Origen Genético en Pacientes Pediátricos Hospitalizados en la Provincia de Ubate, Colombia.

OBJECTIVE: Describing genetic disease frequency in a second-level hospital's in-patient paediatric service METHODS: The hospital's statistical department's records for 2005 were comprehensively reviewed; the study was carried out in the town of Ubaté during 2006. RESULTS: Complex diseases led to nearly 25% of all hospitalisations, including multifactor diseases and congenital malformations. However, an aetiological study and/or geneticist consultation or referral took place on a few occasions. CONCLUSIONS: Primary care hospitals should become more relevant reference centres for detecting genetic diseases amongst the paediatric population. New mechanisms are needed for implementing this to allow patients access to a geneticist and for an aetiological diagnosis to be made and providing suitable genetic counselling.

Alteraciones visuales y oculares en pacientescon síndrome de Down / Visual and ocular alterations in patients with down syndrome

El síndrome de Down hace referencia al conjunto de manifestaciones clínicas producidas por una alteracióncromosómica numérica denominada trisomía 21, esta es la anomalía genética más frecuente en el mundo (1 por cada 700 a 1.000 nacidos vivos). La mayoríade los casos de trisomía 21 están causados por el fracaso en la separación adecuada de los cromosomasdurante la meiosis. Existe una asociación epidemiológicaentre edad materna avanzada y mayor frecuencia de nacimientos con síndrome de Down. El fenotipo de los pacientes con síndrome de Down es variable, siendo las principales características físicas las siguientes: hipotonía, braquicefalia, pliegue epicántico,fisuras inclinadas hacia arriba, puente nasal plano, hipoplasia medio facial, piel redundante en región cervical posterior, pliegue palmar único transversal,hipoplasia de falange media de quinto dedo de manos con clinodactilia, gap entre primer y segundo dedo del pie. El fenotipo clásico incluye también defectoscardiacos congénitos (50 por ciento), anomalías oculares(60 por ciento), apnea obstructiva del sueño (50 al 75 por ciento), enfermedad tiroidea (20 al 40 por ciento), hipoacusia (75 por ciento), otitis media (50 al 70 por ciento), displasia de cadera (6 por ciento), leucemia (1 por ciento), enfermedad de Hirshsprung (1 por ciento), entre otros. El grado de retardo mental es variable y las alteraciones visuales y oculares son diversas y de gran importancia en la morbilidad de estos pacientes,siendo el grupo de mayor riesgo la población pediátrica. Diferentes estudios han comprobado que existe una alta prevalencia de defectos refractivos, alteraciones acomodativas, ambliopía, cataratas, estrabismo,nistagmos e infecciones entre otras.

Down’s syndrome refers to the set of clinical manifestationsproduced by a chromosomal numerical alteration named trisomy 21; this one is the most frequentgenetic anomaly in the world (one for every 700 to 1.000 born alive). The majority of the cases of trisomy 21 are caused by the failure in the suitableseparation of the chromosomes during the meiosis.An epidemiological association exists between mother advanced age and major frequency of births with Down’s syndrome. The phenotype of the patientswith Down’s syndrome is variable , being the principal physical characteristics the following: poor muscle tone, flat back of the head, epicanthic fold, upslanting palpebral fissures, nasal flat bridge, facial features, redundant skin in cervical posterior region, single transverse palmar crease, hipoplasia of average phalanx of fifth finger of hands with clinodactilia, a larger than normal space between the big and second toes, the classic phenotype includes also: congenital heart defects (50 percent), ocular anomalies (60 percent), obstructivesleep apnea (50-75 percent), thyroid dysfunction (20 to 40 percent), deafness (75 percent), otitis media (50-70 percent), hip dysplasia (6 percent), leukemia (1 percent), Hirshsprung’s disease(1 percent), among others. The degree of mental delay is variable and the visual and ocular alterations are diverse and of great importance in the morbidity of these patients, being the group of major risk the pediatricpopulation. Different studies have verified a high prevalence of refractive errors, accommodative disorders, amblyopia, cataracts, strabismus, nistagmosand infections among others. These anomalies alter in significative form the quality of life of the patients and their family, in such a way that a betterdiscernment of the visual and ocular alterations associated with Down’s syndrome gives place to the establishment of preventive actions and early treatmentthat could influence positively in their developmentand future life.

Hand washing frequencies and procedures used in retail food services.

Transmission of viruses, bacteria, and parasites to food by way of improperly washed hands is a major contributing factor in the spread of foodborne illnesses. Field observers have assessed compliance with hand washing regulations, yet few studies have included consideration of frequency and methods used by sectors of the food service industry or have included benchmarks for hand washing. Five 3-h observation periods of employee (n = 80) hand washing behaviors during menu production, service, and cleaning were conducted in 16 food service operations for a total of 240 h of direct observation. Four operations from each of four sectors of the retail food service industry participated in the study: assisted living for the elderly, childcare, restaurants, and schools. A validated observation form, based on 2005 Food Code guidelines, was used by two trained researchers. Researchers noted when hands should have been washed, when hands were washed, and how hands were washed. Overall compliance with Food Code recommendations for frequency during production, service, and cleaning phases ranged from 5% in restaurants to 33% in assisted living facilities. Procedural compliance rates also were low. Proposed benchmarks for the number of times hand washing should occur by each employee for each sector of food service during each phase of operation are seven times per hour for assisted living, nine times per hour for childcare, 29 times per hour for restaurants, and 11 times per hour for schools. These benchmarks are high, especially for restaurant employees. Implementation would mean lost productivity and potential for dermatitis; thus, active managerial control over work assignments is needed. These benchmarks can be used for training and to guide employee hand washing behaviors.

Enfermedades de origen genético en pacientes pediátricos hospitalizados en la Provincia de Ubate, Colombia / Genetic diseases in pediatric patients hospitalised in the town of Ubaté, Colombia

Objetivo Realizar una descripción de la frecuencia de patologías genéticas en el servicio de hospitalización pediátrica de un hospital de segundo nivel de atención. Métodos Revisión completa de los registros del Departamento de Estadística del hospital en el año 2005. El estudio se realizo en el pueblo de Ubaté durante el año 2006. Resultados Cerca del 25 por ciento de las hospitalizaciones, se originó en enfermedades complejas, incluyendo enfermedades multifactoriales y malformaciones congénitas, sin embargo, el estudio etiológico y la valoración por el genetista se llevan a cabo en pocas ocasiones. Conclusiones El hospital de atención primaria debe ser un centro de referencia de mayor relevancia para la detección de patologías de causa genética en la población pediátrica, se requieren nuevos mecanismos para poner en práctica este propósito, con el fin de permitir a los pacientes acceso al genetista y llevar a cabo un diagnóstico etiológico y asesoría genética adecuados.

Objective Describing genetic disease frequency in a second-level hospital's in-patient paediatric service Methods The hospital's statistical department's records for 2005 were comprehensively reviewed; the study was carried out in the town of Ubaté during 2006. Results Complex diseases led to nearly 25 percent of all hospitalisations, including multifactor diseases and congenital malformations. However, an aetiological study and/or geneticist consultation or referral took place on a few occasions. Conclusions Primary care hospitals should become more relevant reference centres for detecting genetic diseases amongst the paediatric population. New mechanisms are needed for implementing this to allow patients access to a geneticist and for an aetiological diagnosis to be made and providing suitable genetic counselling.

Detección de anomalías congénitas en 12.760 nacimientos de tres hospitales en la Ciudad de Bogotá, Colombia 2004-2005 mediante ecografía prenatal / Using prenatal ultrasound for detecting congenital anomalies in 12.760 newborn babies from 20042005 in 3 hospitals in Bogotá, Colombia

Objetivos: determinar la frecuencia de las alteraciones congénitas que son detectadas en forma prenatal, utilizando la ecografía como método diagnóstico. Métodos: estudio de casos y controles basado en la metodología del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC). Fueron examinados los recién nacidos de tres hospitales de la ciudad de Bogotá durante los años 2004 y 2005. Resultados: se reportó un total de 12.760 recién nacidos, de los cuales hubo 382 con malformaciones congénitas (2,99 por ciento). Información completa se presentó en 287 casos (75,13 por ciento). El promedio de ecografías realizadas a los casos fue de 3,47 y para los controles de 3,19 (p < 0,05). Los casos presentaron menores edades gestacionales con respecto a los controles, 37,59 vs. 38,29 semanas respectivamente (p < 0,01); menores pesos al nacer 2.841,9 vs. 3.022,67 g (p < 0,01) y talla de 48,3 cm para los casos y 49,34 para los controles (p < 0,01). Se presentaron 151 casos con posibilidad de detección ecográfica (52,6 por ciento de los malformados), de los cuales solo 49 (32,5 por ciento) fueron detectados. Conclusión: la tasa de detección ecográfica en los tres hospitales es baja comparada con la información de otros estudios, que muestran la necesidad de una mejor calidad y tecnología para incrementar la detección prenatal de malformaciones graves.

Microfiltración bacteriana, citotoxicidad y respuesta del periápice al MTA, al IRM, al super EBA y a la amalgama: una revisión / Bacterial microleakage, cytotoxicity and periapical response to MTA, IRM, super EBA and amalgam: a review

El propósito de esta revisión es establecer parámetros claros de cuáles métodos son los más adecuados para el estudio de la microfiltración, de la citotoxicidad y de la respuesta del periápice al MTA, la amalgama, el super EBA y el IRM como materiales de retroobturación, pues existen diversos métodos empleados en estas investigaciones, dentro de los cuales hay muchos que no ofrecen respuestas satisfactorias, ya sea porque son análogos con la clínica o por limitaciones intrínsecas de la prueba. La función principal de un material de obturación retrógrada es ofrecer sellado apical, para prevenir la colonización bacteriana y la difusión de sus productos desde el conducto a los tejidos periapicales. Las pruebas de microfiltración, citotoxicidad y los tests de implantación son las más empleadas en el estudio de estos materiales, pues a través de ellas se busca evaluar la compatibilidad con los tejidos y su capacidad de sellado. Las características de sellado, la adaptación marginal, las pruebas de citotoxicidad in vitro y las pruebas de uso e implantación en animales experimentales son altamente significativas para eliminar materiales con grados inaceptables de filtración y pobre biocompatibilidad. Estas pruebas son prerrequisitos y no sustitutos de estudios clínicos. La comparación clínica de los materiales de obturación retrógrada bajo condiciones similares quirúrgicas y postoperatorias debe ser el método más relevante para la evaluación del uso clínico y de su eficiencia a largo plazo