Restaurant Food Allergy Practices - Six Selected Sites, United States, 2014.

Food allergies affect an estimated 15 million persons in the United States (1), and are responsible for approximately 30,000 emergency department visits and 150-200 deaths each year (2). Nearly half of reported fatal food allergy reactions over a 13-year period were caused by food from a restaurant or other food service establishment (3). To ascertain the prevalence of food allergy training, training topics, and practices related to food allergies, CDC's Environmental Health Specialists Network (EHS-Net), a collaborative forum of federal agencies and state and local health departments with six sites, interviewed personnel at 278 restaurants. Fewer than half of the 277 restaurant managers (44.4%), 211 food workers (40.8%), and 156 servers (33.3%) interviewed reported receiving food allergy training. Among those who reported receiving training, topics commonly included the major food allergens and what to do if a customer has a food allergy. Although most restaurants had ingredient lists for at least some menu items, few had separate equipment or areas designated for the preparation of allergen-free food. Restaurants can reduce the risk for allergic reactions among patrons by providing food allergy training for personnel and ingredient lists for all menu items and by dedicating equipment and areas specifically for preparing allergen-free food.

A Systematic Review of Symptoms for the Diagnosis of Ovarian Cancer.

CONTEXT: Ovarian cancer is common and has significant morbidity and mortality, partly because it is often diagnosed at a late stage. This study sought to determine the accuracy of individual symptoms and combinations of symptoms for the diagnosis of ovarian cancer. EVIDENCE ACQUISITION: MEDLINE was searched, identifying 2,492 abstracts, reviewing 71 articles in full, and ultimately identifying 17 studies published between 2001 and 2014 that met the inclusion criteria. Data were abstracted by two researchers, and quality was assessed using the QUADAS-2 criteria adapted to the study question. Bivariate random effects meta-analysis was used where possible, and heterogeneity and threshold effects were explored using receiver operating characteristic curves. Data were analyzed in 2015. EVIDENCE SYNTHESIS: Most studies were at high risk of bias, primarily because of case-control design or differential verification bias. The highest positive likelihood ratios (LRs+) were found for presence of abdominal mass (LR+, 30.0); abdominal distension or increased girth (LR+, 16.0); abdominal or pelvic pain (LR+, 10.4); abdominal or pelvic bloating (LR+, 9.3); loss of appetite (LR+, 9.2); and a family history of ovarian cancer (LR+, 7.5). No symptoms were helpful at ruling out ovarian cancer when absent. The Ovarian Cancer Symptom Index was validated in five studies and (after excluding one outlier with different inclusion criteria) was 63% sensitive and 95% specific (LR+, 12.6; LR-, 0.39). Two other symptom scores had not been validated prospectively. CONCLUSIONS: Several individual signs and symptoms significantly increase the likelihood of ovarian cancer when present. More work is needed to validate decision rules and develop new decision support tools integrating risk factors, symptoms, and possibly biomarkers to identify women at increased ovarian cancer risk.

Food Allergy Knowledge and Attitudes of Restaurant Managers and Staff: An EHS-Net Study.

Dining outside of the home can be difficult for persons with food allergies who must rely on restaurant staff to properly prepare allergen-free meals. The purpose of this study was to understand and identify factors associated with food allergy knowledge and attitudes among restaurant managers, food workers, and servers. This study was conducted by the Environmental Health Specialists Network (EHS-Net), a collaborative forum of federal, state, and local environmental health specialists working to understand the environmental factors associated with food safety issues. EHS-Net personnel collected data from 278 randomly selected restaurants through interviews with restaurant managers, food workers, and servers. Results indicated that managers, food workers, and servers were generally knowledgeable and had positive attitudes about accommodating customers' food allergies. However, we identified important gaps, such as more than 10% of managers and staff believed that a person with a food allergy can safely consume a small amount of that allergen. Managers and staff also had lower confidence in their restaurant's ability to properly respond to a food allergy emergency. The knowledge and attitudes of all groups were higher at restaurants that had a specific person to answer food allergy questions and requests or a plan for answering questions from food allergic customers. However, food allergy training was not associated with knowledge in any of the groups but was associated with manager and server attitudes. Based on these findings, we encourage restaurants to be proactive by training staff about food allergies and creating plans and procedures to reduce the risk of a customer having a food allergic reaction.