Knowledge and Behavioral Habits to Reduce Mycotoxin Dietary Exposure at Household Level in a Cohort of German University Students.

Mycotoxins pose a health concern for humans. Therefore, strategies at pre- and post-harvest and maximum levels for food have been implemented, aimed to minimize the risk of dietary exposure. Yet, consumers' dietary habits and life style play a substantial role in overall exposure. The aim of this study was to investigate knowledge of mycotoxins and accordance to behavioral practices or habits that may affect the risk of mycotoxin dietary exposure at the household level or when food commodities are obtained from non-regulated trade markets. For this purpose, an online survey was applied to a university student cohort (n = 186). The survey consisted of 23 questions grouped in five categories: Socio-demographic and income data, general life style and habits, knowledge about mycotoxins, compliance with the "17 golden rules to prevent mycotoxin contamination" of the German Federal Institute for Risk Assessment (BfR), and measures towards reducing health risks. We paid particular attention to knowledge and compliance of a group acquiring food items in markets outside regulation and surveillance, namely, adherents of food movements such as food sharing or dumpster diving. The results of our study indicate a generally rather low level of knowledge about mycotoxins in the investigated cohort, as well as a weak perception of their associated risks compared to similar studies; around half of the cohort was unfamiliar with the term "mycotoxin" and the health risks of mycotoxins were considered comparable to those of pesticides, heavy metals, microplastics and food additives. We observed, in general, a relatively high degree of compliance with the proposed golden rules. The rules with the highest compliance related to deteriorated foods with visible signs of fungal infestation, probably because these are already considered as food waste. Rules that were less followed included those that require a specific knowledge of food storage and early fungal contamination stages, namely preventive measures related to storage of bread. Adherents of food movements did not differ significantly with the control group in terms of knowledge, risk perception and compliance with the 17 golden rules. This may be due to the homogeneity of the cohort in terms of demography, age and educational level. However, significant low compliance in the food movements group was observed with the rules "Buy fruit and vegetables that are as intact as possible, i.e., without injuries and bruises" and "Rotten fruit should neither be eaten nor further processed into compote or jam", possibly because of ideological convictions around reducing food waste. In conclusion, mycotoxin prevention strategies should not end at the retail level; in particular, clarification and information regarding health risk from mycotoxins are suggested in order to reduce the risk of exposure in private households or in informal trade markets. The results of this study should, however, be interpreted with caution due to the specific characteristics of the cohort in terms of age and educational level and the disparity in size between the control and the food movement group. This study is a starting point for evaluating and understanding the consumer perspective on mycotoxins.

Nutraceuticals as Potential Radionuclide Decorporation Agents.

Exposure of individuals to radioactive material as a result of ingestion of contaminated food and water is an increasing public health concern. Unfortunately, there are limited treatment modalities for dealing with these types of potentially toxic exposures. Recent research suggests that many plant-based nutraceuticals may possess metal-binding properties. This preliminary study investigated the ability of genistein, curcumin, quercetin, and lentinan to bind metals considered internal contamination risks, namely cesium, uranium, cobalt, and strontium, in a variety of matrices. The efficacy of these nutraceuticals in protecting cultured cells from metal-induced toxicity was also explored. Results showed that none of the compounds bound cesium or strontium. However, genistein, curcumin, and quercetin could bind uranium. Curcumin and quercetin also bound cobalt and could also protect cultured cells from metal-induced cytotoxicity. Lentinan did not bind any of the metals tested. Metal binding was also pH dependent, with no binding observed at lower pH values. This project showed that nutraceuticals could function as chelators for metals considered internal radionuclide contamination hazards. Further investigations are required in order to determine whether these compounds will become a new nontoxic arsenal of pharmaceutical compounds with which to treat radionuclide contamination.

Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review.

A gluten-free diet (GFD) is currently the only effective treatment for celiac disease (CD); an individual's daily intake of gluten should not exceed 10 mg. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten, despite their best efforts at dietary modifications. It has been demonstrated that both natural and certified gluten-free foods can be heavily contaminated with gluten well above the commonly accepted threshold of 20 mg/kg. Moreover, meals from food services such as restaurants, workplaces, and schools remain a significant risk for inadvertent gluten exposure. Other possible sources of gluten are non-certified oat products, numerous composite foods, medications, and cosmetics that unexpectedly contain "hidden" vital gluten, a proteinaceous by-product of wheat starch production. A number of immunochemical assays are commercially available worldwide to detect gluten. Each method has specific features, such as format, sample extraction buffers, extraction time and temperature, characteristics of the antibodies, recognition epitope, and the reference material used for calibration. Due to these differences and a lack of official reference material, the results of gluten quantitation may deviate systematically. In conclusion, incorrect gluten quantitation, improper product labeling, and poor consumer awareness, which results in the inadvertent intake of relatively high amounts of gluten, can be factors that compromise the health of patients with CD.

Growth of Listeria monocytogenes in ready-to-eat "shrimp cocktail": Risk assessment and possible preventive interventions.

The present study investigated the presence, growth potential, and public health risk posed by Listeria monocytogenes in a ready-to-eat "shrimp cocktail". The pathogen was detected in 4 out of the 104 samples, and there were no counts above the enumeration limit (1 Log colony-forming unit (CFU)/g); the product was a suitable substrate for pathogen growth owing to its chemical/physical properties. A stochastic quantitative microbial risk assessment (QMRA) was performed to estimate the expected number of invasive listeriosis cases caused by the consumption of 10,000 servings of the product on the last day of its shelf life, considering a population comprising healthy consumers, those susceptible, and transplant recipients. The model predicted no cases for this scenario. Uncertainties were included by considering alternative scenarios; even when considering an increased mean bacterial concentration (up to 3-4 Log CFU/g), no cases were estimated. Following a producer's demand, the exposure assessment model was also used to estimate the probability of the product exceeding the threshold of 2 log CFU/g during the shelf life. The possibility of Listeria growth in the product could not be avoided. Therefore, a modification of the production process was tested to re-classify the product as unsuitable for Listeria growth (EC Reg. 2073/2005). The shrimps were conditioned in three different organic acid solutions comprising: acetic acid (1500 ppm) (A); benzoic acid (1500 ppm) + acetic acid (500 ppm) + lactic acid (750 ppm) (BLA); and lactic acid (4500 ppm) + sodium acetate (2500 ppm) (LSA). Testing was conducted over various treatment durations (1 day-5 days). Treatment for 2 days in the LSA solution was selected based on efficacy, the absence of consumer-perceptible sensorial modifications, and the producers' production rate requirements. The concentration of L. monocytogenes decreased when the new process was applied, which confirmed the usefulness and effectiveness of the treatment relative to the traditional process. Thus, the product obtained by the modified production process did not support the growth of L. monocytogenes.

Significance of and Challenges in Regulating Endocrine Disruptors - How Regulators and Industry Can Conquer?

Endocrine disruptors (EDs) disrupt the standard operation of the endocrine systems, resulting in untoward effects. EDs have gained extensive consideration due to their severe adverse impacts on public and wildlife health. A variety of compounds from both natural and synthetic origin may cause endocrine disruptions. These may be found in industrial chemicals, persistent organic pollutants, and products of regular use including pharmaceuticals, medical equipment, implants, medical/surgical and dental devices, cosmetics, food products, other consumer goods, their packaging and processing materials. Apart from direct consumption or use, these chemicals may impact by entering our food chain or ecosystem. These chemicals act by mimicking the hormones or blocking their receptors or interfering in their normal production, absorption, distribution, metabolism and excretion. The implementation of a regulatory framework on the complex multidisciplinary field of EDs brings enormous challenges, which pose barriers to the regulatory process. This study aims to focus on the key public and ecological health concerns presented by EDs, challenges faced by regulators to achieve successful regulatory proposition and the importance of collaboration endeavours to potentially conquer such challenges. Endocrine-disrupting chemicals (EDCs) or EDs can impact at low exposure levels, bringing about a broad range of health issues including disorders related to reproductive, fetal development, neurological, immunological, metabolic and cancer, etc. They may cause health effects across generations. The regulatory frameworks available across major regulators are tackling the identification of EDs and their mechanisms to provide necessary guidance on the safety and disposal of such substances. However, the challenges faced outweigh the regulatory mechanisms in place. The major challenges are related to structural ranges at times leading to no representative structures, active metabolites, substantiate quantum, delayed effects, epigenetic changes, widespread existence, concentration correlation for different biological species, availability of appropriate methods, exposure to a mixture of chemicals, complex endocrinology principles, unknown sources, routes and mechanisms, impacts at early stages of life, geographical movement of EDs, hazard-based vs. risk-based approaches. Regulators of healthcare and environmentalists needs to collaborate amongst them and with wider stakeholders including industry sponsors to find ways of dealing with such challenges and capitalize on the research-based knowledge grid available across institutions. Existence of EDs, their impact on living beings and mechanism of influence are like a tangled web, which induces difficulties in regulating them with conventional mindset. Conquering these challenges necessitates that regulators should join forces amongst themselves, with other institutions operating for environment, with industry sponsors and researchers to achieve success in public health safety.

Cadmium: Mitigation strategies to reduce dietary exposure.

Cadmium has long been recognized as an environmental contaminant that poses risks to human health. Cadmium is of concern since nearly everyone in the general population is exposed to the metal through the food supply and the ability of the element to accumulate in the body over a lifetime. In support of the United States Food and Drug Administration's (FDA) Toxic Element Working Group's efforts to reduce the risks associated with elements in food, this review sought to identify current or new mitigation efforts that have the potential to reduce exposures of cadmium throughout the food supply chain. Cadmium contamination of foods can occur at various stages, including agronomic production, processing, and consumer preparation for consumption. The presence of cadmium in food is variable and dependent on the geographical location, the bioavailability of cadmium from the soil, crop genetics, agronomic practices used, and postharvest operations. Although there are multiple points in the food supply system for foods to be contaminated and mitigations to be applied, a key step to reducing cadmium in the diet is to reduce or prevent initial uptake by plants consumed as food or feed crops. Due to complex interactions of soil chemistry, plant genetics, and agronomic practices, additional research is needed. Support for field-based experimentation and testing is needed to inform risk modeling and to develop practical farm-specific management strategies. This study can also assist the FDA in determining where to focus resources so that research and regulatory efforts can have the greatest impact on reducing cadmium exposures from the food supply. PRACTICAL APPLICATION: The presence of cadmium in food is highly variable and highly dependent on the geographical location, the bioavailability of cadmium from the soil, crop genetics, and agronomic practices used. This study can assist the FDA in determining where to focus resources so that research and regulatory efforts can have the greatest impact on reducing cadmium exposures from the food supply.

Mycotoxin management in a developing country context: A critical review of strategies aimed at decreasing dietary exposure to mycotoxins in Zimbabwe.

Mycotoxins are unavoidable environmental contaminants, which are found throughout the food chain, particularly in cereals. Mycotoxin management is not effective in developing countries, such as Zimbabwe, due to resource constraints, yet human health risk is evident. Various practical mitigation strategies that can be employed to decrease human dietary exposure to mycotoxins as a means of preliminary steps towards risk management are discussed. These strategies were stratified into two categories. First, crop/commodity-centred strategies, mainly the pre-harvest actions of cultivar selection, bio-control, as well as good agricultural practices (GAP), and the post-harvest actions including timeous harvesting, appropriate drying and storage technologies, are elaborated making use of hazard analysis critical control points (HACCP) principles. The role of legislation is also explored as a crop/commodity centred mitigation strategy. Second, human-centred strategies anchored on dietary diversity and the use of socio-cultural approaches as a direct means of reducing mycotoxin exposure are discussed. Finally, an integrated science-based mycotoxin management strategy, encompassing targeted legislation on mycotoxins, consumer education and information sharing, human and institutional capacity building, training and financing, is suggested in addition to GAP, as a means of reducing human health risk associated with mycotoxin exposure in Zimbabwe.HighlightsFarm-to-fork HACCP-based mycotoxin managementHuman-centred mycotoxin management approaches are keyAgronomy, technology and legislation critical in reducing mycotoxin exposure.

U.S. Food and Drug Administration's interim reference levels for dietary lead exposure in children and women of childbearing age.

Reducing lead exposure is a public health priority for the US Food and Drug Administration as well as other federal agencies. The goals of this research were to 1) update the maximum daily dietary intake of lead from food, termed an interim reference level (IRL), for children and for women of childbearing age (WOCBA) and 2) to confirm through a literature review that with the exception of neurodevelopment, which was not evaluated here, no adverse effects of lead consistently occur at the blood lead level (BLL) associated with the IRL. Because no safe level of lead exposure has yet been identified for children's health, the IRLs of 3 µg/day for children and 12.5 µg/day for WOCBA were derived from the Centers for Disease Control and Prevention reference value of 5 µg/dL BLL, the level at which public health actions should be initiated. The literature review showed that no adverse effects of lead consistently occurred at the BLL associated with the IRLs (0.5 µg/dL). The IRLs of 3 µg/day for children and 12.5 µg/day for WOCBA should serve as useful benchmarks in evaluating the potential for adverse effects of dietary lead.

Gluten Detection Methods and Their Critical Role in Assuring Safe Diets for Celiac Patients.

Celiac disease, wheat sensitivity, and allergy represent three different reactions, which may occur in genetically predisposed individuals on the ingestion of wheat and derived products with various manifestations. Improvements in the disease diagnostics and understanding of disease etiology unveiled that these disorders are widespread around the globe affecting about 7% of the population. The only known treatment so far is a life-long gluten-free diet, which is almost impossible to follow because of the contamination of allegedly "gluten-free" products. Accidental contamination of inherently gluten-free products could take place at any level from field to shelf because of the ubiquity of these proteins/grains. Gluten contamination of allegedly "gluten-free" products is a constant threat to celiac patients and a major health concern. Several detection procedures have been proposed to determine the level of contamination in products for celiac patients. The present article aims to review the advantages and disadvantages of different gluten detection methods, with emphasis on the recent technology that allows identification of the immunogenic-gluten peptides without the use of antibodies. The possibility to detect gluten contamination by different approaches with similar or better detection efficiency in different raw and processed foods will guarantee the safety of the foods for celiac patients.

Critical review of mercury contamination in Sri Lankan fish and aquatic products.

Mercury (Hg) in fish and aquatic products is a potential threat to human health and international trade, and guidelines of international advisory bodies are established for assessing Hg in these foods. As fish are the most consumed animal protein in Sri Lanka, this assessment summarises for the first-time total mercury concentrations in Sri Lankan marine and freshwater fish, invertebrates, aquatic plants, and fisheries products. It reveals that Hg levels in fish and other edible aquatic species are mostly below the published safety limits, except for certain top trophic level fish (swordfish, tuna, marlin). The review also highlights gaps in Sri Lankan Hg assessments such as a total lack of data for methyl­mercury in these aquatic species and food products. This data compilation and assessment will serve as an initial baseline for comparison with results from future monitoring and research studies in Sri Lanka while adding to the world-wide Hg database.

Using disease-burden method to evaluate the strategies for reduction of aflatoxin exposure in peanuts.

Aflatoxin is a fungal secondary metabolite with high toxicity that is capable of contaminating various types of food crops. It has been identified as a Group 1 human carcinogen by the International Agency for Research on Cancer. Chronic aflatoxin exposure has caused worldwide concern as a matter of public food safety. Peanuts and peanut products are the major sources of aflatoxin exposure. Therefore, some reduction interventions have been developed to minimize contamination throughout the peanut production chain. The purpose of this study is to estimate the efficacy of interventions in reducing the health impact of hepatocellular carcinoma caused by aflatoxin contamination in peanuts. The estimated total Disability-Adjusted Life Years (DALYs) were calculated using FDA-iRISK software. Six aflatoxin reduction strategies were evaluated, including good agricultural practice (GAP), biocontrol, Purdue Improved Crop Storage packaging, basic processing, ozonolysis, and ultraviolet irradiation. The results indicated that basic processing could prevent huge public health loss of 4,079.7-21,833 total DALYs per year. In addition, GAP and biocontrol were both found to be effective strategies in the farm field. Meanwhile, the other three interventions had limited effectiveness in reducing total DALYs. In conclusion, this study could help farmers, processing plants, and government policy makers to alleviate aflatoxin contamination issues in the peanut production chain.

Dietary Compounds To Reduce In Vivo Inorganic Arsenic Bioavailability.

It is estimated that approximately 200 million people are exposed to arsenic levels above the World Health Organization provisional guideline value, and various agencies have indicated the need to reduce this exposure. In view of the difficulty of removing arsenic from water and food, one alternative is to reduce its bioavailability (the amount that reaches the systemic circulation after ingestion). In this study, dietary components [glutathione, tannic acid, and Fe(III)] were used to achieve this goal. As(III) or As(V) (1 mg/kg body weight) was administered daily to BALB/c mice, along with the dietary components, for 15 days. The results confirm the efficacy of Fe(III) and glutathione as reducers of arsenic bioavailability and tissue accumulation. Also, these treatments did not result in reductions of Ca, K, P, and Fe contents in the liver. These data suggest that use of these two compounds could be part of valid strategies for reducing inorganic arsenic exposure in chronically exposed populations.

Polycyclic aromatic hydrocarbons and potentially toxic elements in seafood from the Persian Gulf: presence, trophic transfer, and chronic intake risk assessment.

High bioavailability of man-made pollutants in marine environments raises serious concern regarding the safety of seafood. In the present study, the presence, trophic transfer, and risks of polycyclic aromatic hydrocarbons (PAHs), and potentially toxic elements (PTEs) in 170 benthic marine organisms (87 prawn; 28 crab; 55 fish) from the Persian Gulf were investigated. Among investigated species, E. coioides displayed the lowest level of metal pollution index (MPI), while P. armatus and P. semisulcatus showed the highest level of MPI and total PAHs, respectively. Principal component biplot exhibited a significant association of PTEs (except Hg) and PAHs in less motile benthic species. The results of trophic transfer investigation revealed that PTEs (except Hg) and PAHs were not biomagnified in the studied organisms through diet. However, Hg biomagnification factors greater than 1 indicated trophic transfer of mercury. In order to gain nutritional benefits of seafood, consumption of two fish/prawn meals/week for adults (except vulnerable groups such as pregnant women) and one fish/prawn meals/week for children is recommended. However, lifelong consumption of crabs (P. armatus) may threaten human health. In addition, the maximum allowable fish consumption rate (CRlim) for studied fish is 120 g fish/day for adults and 30 g fish/day for children. In the case of prawns, the safe dose is 30 and 10 g prawns/day for adults and children, respectively.

Efficacy of a school-based intervention to bring awareness about PCB contamination and exposure avoidance in Guánica, Puerto Rico.

Production of polychlorinated biphenyls (PCB) was banned in the US in 1970s. However, susceptible populations especially those living at/around the contaminated sites continue to be at a risk of elevated exposure to PCBs because information about the contamination (of the environment) and its associated health risks may not reach these populations. A recent study found the second highest concentration of PCBs ever recorded worldwide in the sediment samples of Guánica Bay, located in the southwestern part of Puerto Rico. PCB levels in fish from the bay were also higher than the tolerance limit of Food and Drug Administration (FDA), which motivated this research to initiate a school-based campaign to bring community awareness about the contamination of the bay and engage students in preventive strategies to reduce their exposure to PCBs. Surveys before and after the campaign were administered in the high school as well as in the communities of Guánica Municipality. The analyses of the survey data suggest that the campaign was effective in bringing awareness among schoolchildren (6.6% before versus 69.7% after the campaign; χ2 ~ 60.4; p < 0.001) and strategies to reduce PCB exposure and its toxicity such as removing adipose tissues from seafood/fish and exercising. In the community, there was a significant decline in the consumption of seafood/fish harvested from the bay after the campaign (54.6% before versus 33% after the campaign; χ2 ~ 10.85; p < 0.001). However, the awareness did not result in significant behavior modifications among schoolchildren, such as avoiding swimming and fishing in the bay. Given hazardous levels of PCBs and some students use the bay for various purposes, including one-third of community members still use seafood/fish harvested from the bay, attention of different stakeholders is warranted for clean-up efforts as well as engaging children and communities in PCB exposure avoidance strategies.

Composting of municipal solid waste by different methods improved the growth of vegetables and reduced the health risks of cadmium and lead.

Reutilization of putrescible municipal solid wastes (MSW) in agriculture can provide valuable plant nutrients. However, it may pose serious noncarcinogenic health risks for a human when contaminants, especially the heavy metals in MSW, end up in plants through the waste-soil-plant continuum. This study examined the effects of composting methods viz. aerobically (AC), anaerobically (ANC), and aerobic-anaerobically (AANC) composted MSW material on (i) fertilizer value: vegetable yield, nitrogen (N) mineralization, and apparent N recovery (ANR); and (ii) associated health risks: selected heavy metal concentration, daily intake of metals (DIM), health risk index (HRI), hazard index (HI), and target hazard quotient (THQ) when applied to a loamy soil. All the aforementioned compost materials were incorporated into the sandy loam soil filled in pots and carrot and spinach were cultivated for 85 and 90 days, respectively. After soil application, between 51 and 56% of the applied organic N was mineralized from ANC material, while the values in case of AC and AANC were 26-31% and 34-40%, respectively. Consequently, dry matter yield and vegetable N uptake from composts were in the order ANC > AANC > AC (P < 0.05). Further, vegetable ANR was the highest from ANC (56 and 56%) than AANC (42 and 45%), and AC (30 and 33%) for spinach and carrot, respectively (P < 0.05). Interestingly, plant uptake of lead and cadmium was lowest from ANC as compared to AC or AANC (P < 0.05), irrespective of the vegetable type. Consequently, DIM, HRI, and THQ for these metals were substantially lower in the former as compared to the latter compost materials. Further, HI from ANC material was 50% lower over the unfertilized control indicating the absence of noncarcinogenic human health risks via vegetable intake. This all indicates that from viewpoint of sustainable waste recycling in agriculture, anaerobic composting is superior to the other composting methods.

Arsenic in groundwater in private wells in rural North Dakota and South Dakota: Water quality assessment for an intervention trial.

Elevated exposure to arsenic disproportionately affects populations relying on private well water in the United States (US). This includes many American Indian (AI) communities where naturally occurring arsenic is often above 10 µg/L, the current US Environmental Protection Agency safety standard. The Strong Heart Water Study is a randomized controlled trial aiming to reduce arsenic exposure to private well water users in AI communities in North Dakota and South Dakota. In preparation for this intervention, 371 households were included in a community water arsenic testing program to identify households with arsenic ≥10 µg/L by inductively coupled plasma mass spectrometry (ICP-MS). Arsenic ≥10 µg/L was found in 97/371 (26.1%) households; median water arsenic concentration was 6.3 µg/L, ranging from <1-198 µg/L. Silica was identified as a water quality parameter that could impact the efficacy of arsenic removal devices to be installed. A low-range field rapid arsenic testing kit evaluated in a small number of households was found to have low accuracy; therefore, not an option for the screening of affected households in this setting. In a pilot study of the effectiveness of a point-of-use adsorptive media water filtration device for arsenic removal, all devices installed removed arsenic below 1 µg/L at both installation and 9 months post-installation. This study identified a relatively high burden of arsenic in AI study communities as well as an effective water filtration device to reduce arsenic in these communities. The long-term efficacy of a community based arsenic mitigation program in reducing arsenic exposure and preventing arsenic related disease is being tested as part of the Strong Heart Water Study.

Effect of common processing of soybeans on the enzymatic activity and detectability of the protein, Dicamba Mono-Oxygenase (DMO), introduced into dicamba-tolerant MON 87708.

Assessing the safety of genetically engineered crops includes evaluating the risk (hazard and exposure) of consuming their newly expressed proteins. The dicamba monooxygenase (DMO) protein, introduced into soybeans to confer tolerance (DT) to dicamba herbicide, was previously characterized and identified to pose no food or feed safety hazards. Most agricultural commodities (e.g., soybeans, maize) enter the food supply after processing methods that can include exposure to high temperatures, harsh solvents or pH extremes that can adversely impact the structure and function of proteins. To understand the likelihood of exposure to DMO in foods from DT soy, enzymatically active and/or immunodetectable forms of DMO were measured in pilot-scale productions of two soy foods (soymilk and tofu), and eight processed fractions (full fat flour, inactivated full fat flour, defatted flour, toasted meal, protein isolate, protein concentrate, crude lecithin, and refined, bleached and deodorized oil). Western blot analysis detected DMO in tofu and in five of the eight processed fractions. DMO activity was not detected in either soymilk or tofu, nor in six of the eight processed fractions. Therefore, many commercial soy processing methods can denature and/or degrade introduced proteins, like DMO. Although the DMO protein has shown no evidence of hazard, this study demonstrates that processing further reduces any food or feed risk by limiting dietary exposure to intact DMO protein.

Customers' Knowledge, Attitude, and Practices towards Food Hygiene and Safety Standards of Handlers in Food Facilities in Hanoi, Vietnam.

Efforts to prevent foodborne illnesses in food facilities require sufficient knowledge on hygiene and safety standards from both food processors and customers. However, studies about knowledge, attitude, and practices of customers towards these issues are constrained. This study explored the knowledge, attitude, and practices (KAP) of customers regarding the practices of food facilities as well as potential associated factors. A cross-sectional survey was conducted in Hanoi from September to October 2015. Questions about knowledge, attitude, and practice towards food hygiene and safety were asked, alongside sociodemographic characteristics. Multivariate Tobit regression was used to identify the associated factors with the KAP. Among 1740 customers, the highest mean score of 98.4 (SD = 10.1) was found in knowledge about practices with raw and cooked food, following by knowledge about environmental practices when processing food (mean = 93.1, SD = 17.3), and knowledge about environmental requirements when processing food (mean = 33.3, SD = 33.3). Most of customers considered the processing and selling of hygienic meals without leaving any food overnight as the most important feature for food facilities (73.8%). About 63.2% of participants chose not to report food safety violation by facilities to authorities. The higher score of knowledge was found in groups of people who were not single, had college/university or higher education, and had specific criteria when choosing their places to eat. These findings imply the need for enhancing customers' protection systems, the capability of inspecting and supervising the food processing progress by local authorities, and the awareness of customers about the environmental requirements of food facilities.

Effectiveness of Prevailing Flush Guidelines to Prevent Exposure to Lead in Tap Water.

Flushing tap water is promoted as a low cost approach to reducing water lead exposures. This study evaluated lead reduction when prevailing flush guidelines (30 s⁻2 min) are implemented in a city compliant with lead-associated water regulations (New Orleans, LA, USA). Water samples (n = 1497) collected from a convenience sample of 376 residential sites (2015⁻2017) were analyzed for lead. Samples were collected at (1) first draw (n = 375) and after incremental flushes of (2) 30⁻45 s (n = 375); (3) 2.5⁻3 min (n = 373), and (4) 5.5⁻6 min (n = 218). There was a small but significant increase in water lead after the 30 s flush (vs. first draw lead). There was no significant lead reduction until the 6 min flush (p < 0.05); but of these samples, 52% still had detectable lead (≥1 ppb). Older homes (pre-1950) and low occupancy sites had significantly higher water lead (p < 0.05). Each sample type had health-based standard exceedances in over 50% of sites sampled (max: 58 ppb). While flushing may be an effective short-term approach to remediate high lead, prevailing flush recommendations are an inconsistently effective exposure prevention measure that may inadvertently increase exposures. Public health messages should be modified to ensure appropriate application of flushing, while acknowledging its short-comings and practical limitations.