Effects of health educational and participatory consumer group interventions in improving food handling practices in regional director of health services area Kalutara, Sri Lanka: non-randomized controlled community trial.

INTRODUCTION: Safe and nutritious food is the key to sustaining life and promoting good health. Unsafe food creates a vicious cycle of disease and malnutrition, particularly affecting infants, young children, the elderly, and the sick. METHODS: The study consisted of two phases, a descriptive cross-sectional study, and an intervention study. Both studies were conducted in the Regional Director of Health Services area, Kalutara, Sri Lanka. The descriptive cross-sectional study [food handlers (n = 904), food establishments (n = 421)] was conducted with the objective of determining factors associated with food handling practices among food handlers and in food establishments. The interventional study was a three-arm non-randomized controlled community trial (n = 50 per arm) with interventions of a participatory consumer group, educational package group, and control group. RESULTS: The food establishments assessment tool (FEAT) contained 11 domains including 75 items with more than a hundred assessment points with a guide to conduct an assessment of food handling. The descriptive cross-sectional study found that food handlers' knowledge of food handling practices of storing milk, fish, and meat and fast-food items containing fish and meat was very poor (96.6%). Visibility of the last place of processing inside the food establishments to consumers was inadequate (19.2%) and the absence of the above-mentioned factor was significantly associated with an unsatisfactory level of food handling score in food establishments (p = 0.03). The unsatisfactory level of food handling was significantly higher among food establishments with non-personal ownership (p = 0.005), a low number of notices issued by legal authorities (p = 0.02), dereliction of duty by owners/managers on supervising (p < 0.001) and lack of medical certification to food handlers (p < 0.0001). Participatory consumer group intervention and educational package interventions were effective in improving food handling practices in food establishments and among food handlers (p < 0.0001). Two independent sample analysis using the Mann-Whitney U test showed, the best improvement in food handling practices was by participatory consumer group intervention (p < 0.0001) and the second was educational package intervention (p < 0.0001). CONCLUSIONS: Knowledge and practices of food handling among participants were poor. A participatory consumer group is more effective than an educational package on improving food handling practices both among food handlers and in food establishments.

Smoking and mental disability : A mixed observational study using a diverse sample of medical-social establishments and services / Tabagisme et handicap psychique : étude observationnelle mixte dans un échantillon diversifié d'établissements et de services médico-sociaux.

INTRODUCTION: A multi-center observational study was carried out in ten ESMS, using a mixed methodology (site visits, questionnaire survey, semi-directive group interviews with professionals and individual interviews with users). PURPOSE OF THE RESEARCH: The aim of this article is to describe the management and prevention of smoking in ESMS for people with mental health disorders, and to characterize and identify the smoking behaviors and representations of ESMS users and the professionals working there. RESULTS: The study made it possible to distinguish between ESMS in terms of the organization of smoking areas and tobacco prevention initiatives. It also revealed that 37 percent of respondents among the professionals said they smoked tobacco, with some of them explaining that they smoked with users and sometimes gave them cigarettes. With regard to prevention, there was a consensus among professionals that they should help users who wanted to stop smoking. Professionals were divided, however, on the need for more active prevention, citing the users' freedom and the fact that ESMS are places where people live. Among the users, 47 percent said they were smokers. Of the users who smoked, 55 percent said they wanted to stop. Interviews with the users revealed that twelve of them wanted to quit, with some asking for help and more assistance from professionals. CONCLUSIONS: This report suggests that intervention research could be developed in ESMS for people with mental health disorders, who could benefit from the smoking prevention actions identified in the facilities and services investigated.

Introduction: Une étude observationnelle multicentrique a été réalisée dans dix ESMS et mobilisait une méthodologie mixte (visite des structures, enquête par questionnaires, entretiens semi-directifs collectifs avec des professionnels et individuels avec des usagers). But de l'étude: Cet article vise à décrire la gestion et la prévention du tabagisme dans des établissements et services médico-sociaux (ESMS) accueillant des personnes avec un trouble psychique, et à caractériser et identifier les comportements tabagiques et les représentations de leurs usagers et professionnels. Résultats: L'étude a permis de distinguer les ESMS au regard de l'organisation des espaces du tabagisme et des actions de prévention du tabac. Elle a permis également de constater que 37 % des professionnels qui ont répondu déclaraient fumer du tabac, une partie d'entre eux expliquant fumer avec les usagers et leur donner parfois des cigarettes. Concernant la prévention, un consensus se dégageait chez les professionnels sur le fait d'aider les usagers qui souhaitaient arrêter. Les professionnels étaient cependant divisés à l'égard d'une prévention plus active, invoquant la liberté de l'usager et le fait que les ESMS sont des lieux de vie. 47 % des usagers se disaient fumeurs. 55 % des usagers fumeurs déclaraient vouloir arrêter. Les entretiens avec les usagers ont permis de constater que douze d'entre eux souhaitaient arrêter, une partie réclamant de l'aide et d'être davantage aidés par les professionnels. Conclusions: Cet état des lieux invite à développer des recherches interventionnelles dans les ESMS accueillant des personnes avec un trouble psychique qui pourraient tirer profit des actions de prévention du tabac repérées dans des structures enquêtées.

Enteric Bacterial Infections, Antimicrobial Susceptibility Pattern, Intestinal Parasites, and Associated Factors Among Food Handlers in Yabelo Town, Borena Zone, Southern Ethiopia.

Background: Foodborne illnesses are the main cause of morbidity and mortality in the twenty-first century, and food handlers are the main source of these illnesses. Objective: The study aimed to assess the prevalence of intestinal parasites, enteric bacteria, antimicrobial susceptibility patterns, and associated factors among food handlers working in a food and drinking establishment in Yabelo town, Borena zone, Southern Ethiopia, in 2022. Methods: A facility-based cross-sectional study design was employed to assess the food handler's state of health. Data were gathered using semistructured questionnaires and observational checklists, and 396 regular stool samples were collected. Samples were examined with microscopy and bacteriological culture to isolate enteric bacteria. Statistical Package for the Social Sciences, version 26 The factors that had a P-value of <.05 were considered statistically significant. Result: Of the 396 stool samples collected, 164 (41.4%) were tested positive for intestinal parasites, while 40 (10.1%) were positive for enteric bacteria (Salmonella and Shigella). Among intestinal parasites, the most predominant parasite was Ascaris lumbricoides 48 (12.1%). All isolates of Salmonella and Shigella showed resistance to ampicillin. In multivariable analysis, not trimming fingernails regularly (AOR = 2.02, 95% CI 1.97-5.37), not washing hands with soap after the toilet (AOR = 3.02, 95% CI 2.37-5.62), and eating raw food (AOR = 2.1, 95% CI 1.79-6.51) have a significant association with the prevalence of bacteria and parasites. Conclusion: The majority of food handlers had poor hygiene practices, and the prevalence of parasites and bacteria was high in the study setting. Educational status, eating raw vegetables or fruit, hand washing after the toilet, and fingernail trimming have associations with the health status of food handlers.

Development of educational package and participatory consumer groups to improve food handling practices in food establishments in Sri Lanka.

Objectives: Improper food handling contributes to many foodborne diseases and food outbreaks globally leading to witnessed morbidities and mortalities. The study aims to develop an educational package and participatory consumer groups to improve food handling practices among food handlers and in food establishments in the Regional Director of Health Services area, Kalutara, Sri Lanka. Methods: The study developed an educational package and participatory consumer groups to improve the food handling practices among food handlers and in food establishments. The critical knowledge gaps were identified during the first component of this study, which was conducted as a descriptive study, and the findings were further discussed in the Focus Group Discussion. Posters, info sheets, and workshops were used for educational packages, and four consumer groups were formed. The second component of the study following the development of the interventions was continued as a three-arm, non-randomized controlled community trial for 4 months in the Regional Director of Health Services, Kalutara. Results: The educational package for food handlers was introduced as a package of a workshop, info sheets, posters to display at workplaces, and short refresher training two weekly to direct good food handling practices in food establishments. Consumer groups were strengthened to exercise their legal rights on their purchases and the ratings showed improvements in the hygiene levels with repeated consecutive visits. Conclusions: The novel educational package and participatory consumer groups are designed and implemented to improve food handling practices among food handlers and in food establishments.

Treatment of effluents from Food Services Establishment (FSEs) by physico-chemical processes: a case study for Trinidad & Tobago.

BACKGROUND: Effluents from Food Services Establishments (FSEs) contain primarily Fats, Oil and Grease (FOG) which severely impact on sewers and the environment when released in high concentrations. In Trinidad & Tobago, it is estimated that approximately 231,304 kg/day of unaccounted for FOG bearing wastewaters from FSEs, are released into the environment with no viable treatment in the country. This research explored the optimization of physico-chemical processes for the treatment of FOGs for subsequent release into sewers. RESULTS: Bench-scale studies analysed the characteristics of FSE's effluents from three popular sources, conducted the treatment of these effluents using Jar Tests, and subsequently confirm results via a pilot plant study. Characterization showed the mean concentration of the parameters examined to be; FOG (511 mg/l ± 116 mg/l), Suspended Solids (446 mg/l ± 146 mg/l), Chemical Oxygen Demand (2229 mg/l ± 963 mg/l) and pH (6 ± 0.3). Jar Tests were conducted using Poly-aluminium Chloride (PACl) as coagulant, anionic and cationic polyelectrolytes as flocculant aids with suitable pH adjustments of samples to determine the isoelectric point for the coagulant. Effluent results showed FOG removal levels of 99.9% and final effluent concentration of 0.17 mg/l. This was attained using PACl concentration of 250 mg/l, a 0.1% low cationic polyelectrolyte (CP 1154) at 4 mg/l with the pH of sample adjusted to 8. The pilot plant achieved a 97.4% removal of FOG (residual of 16.8 mg/l) using the same coagulant dosing, and pH value, but increasing the strength of the flocculant aid to 0.1% medium cationic (CP1156) at 5 mg/l. CONCLUSION: Experimentation showed high concentrations of emulsified FOG can be efficiently removed to levels below the permissible requirements (20 mg/l) for entry into sewer systems in Trinidad and Tobago using coagulation, flocculation and sedimentation techniques. Pilot scale study also revealed that a higher strength and/or dose of the cationic polyelectrolyte and increased times in primary and final tanks were required to attain the desired results as in the bench level study, where equipment limitations in the flocculation tank were faced. This is in alignment with theory where factors critical for agglomeration is equipment type and density charge. It is, concluded that the optimum combination of chemicals and the respective dosages attained at the bench level study should prove effective should the right equipment be made available.

Effectiveness of grease interceptors in food service establishments for controlling fat, oil and grease deposition in the sewer system.

The water industry worldwide experiences numerous sewer blockages each year, partially attributed to the accumulation of fat, oil and grease (FOG). Managing this issue involves various strategies, including the requirement for installation of grease interceptors (GIs) installation. However, the claimed efficacy of commercial GIs of eliminating 99 % of FOG has been questioned for many years because FOG deposit formation occurs despite food service establishments (FSEs) using GIs, therefore detailed understanding of FOG wastewater compositions and its removal by GIs is required. This study provides an insight into the key FOG components such as FOG particle size, metals and fatty acid (FA) profile in GI influent and effluent, and within the GI, at three different FSEs. Analysis of FAs identified substantial proportions of extra-long-chain FAs in the effluents, including arachidic (C20:0), behenic (C22:0), mead (C20:3), lignoceric (C24:0), and nervonic (C24:1) acids. In contrast, the household kitchen released palmitic (C16:0), oleic (C18:1) and linoleic (C18:2) acids. It was further observed that scums effectively remove the larger FOG particles, leaving only 10 % below 75.4 µm. Notably, FSEs which employed automatic dishwashers produced up to 80.4 % of particles ≤45 µm, whereas FSEs and household kitchen which used handwash sinks generated only 36.9 % and 26.3 % of particles ≤45 µm, respectively. This study demonstrated that the commercial GIs do not remove FOG entirely but clearly demonstrated that they discharge high concentrations of FOG with extra-long FFAs which were attributed to the occurrence of microbial activity and hydrolysis of triglycerides within the GI, potentially contributing to FOG deposition.

Bacterial Contamination and Antimicrobial Resistance in Drinking Water From Food and Drinking Establishments in Shashemane Town, Ethiopia.

We investigated the bacteriological quality of drinking water and antimicrobial resistance of bacterial isolates in food and drinking establishments in Shashemane town, Ethiopia. A cross-sectional study was conducted from July to August 2022. One hundred water samples were collected from the tap water and storage containers of 50 selected establishments. All the collected samples were analyzed for bacteriological and antimicrobial susceptibility tests using standard procedures. The study found approximately 80% of water samples from the tap and all water samples (100%) from storage containers were contaminated with total coliforms. E. coli was detected in 20% and 26% of water samples from the tap and storage containers, respectively. A total of 68 bacterial isolates were identified, including E. coli (33.8%), Staphylococcus (25%), Salmonella (17.64%), Klebsiella (11.76%), Shigella (10.29%), and Pseudomonas (1.4%). The highest resistance by the isolates was observed against ampicillin (96%), followed by amoxicillin (94%), cotrimoxazole (76.8%), chloramphenicol (36%), gentamycin (23%), ciprofloxacin (23%), and ceftriaxone (12%). The study concluded that drinking water in food and drinking establishments was found vulnerable to microbiological contamination and it is a health risk to consumers. The level of contamination in stored water was found higher than tap water. In addition, antimicrobial-resistant bacteria such as E. coli, Salmonella, Shigella, Klebsiella, and Staphylococcus aureus were detected in both tap water and stored water. Therefore, awareness should be given to food handlers and owners of the establishments on hygienic water handling practices by the regulatory bodies of Shashemane town and stakeholders.

Food Safety Practices during Hajj: On-Site Inspections of Food-Serving Establishments.

The presence of crowds during Hajj increases the risk of foodborne infection. Yet, research on the practices of food handlers during Hajj is limited. This study aimed to assess compliance with food safety practices and its associated factors during Hajj 2022. An observational cross-sectional study was conducted in Mecca and Madinah before and during Hajj 2022 and involved 195 food-serving establishments (FSEs) contracted for Hajj catering. Collected data included visit time, establishment location, licensure, whether food handlers had food safety training (professional training), and whether FSEs were under supervision from a consulting office (professional supervision). The included FSEs were 168/195 (86.2%). Two-thirds of FSEs surveyed (113, 67.3%) were under professional supervision, and 91 (54.2%) hired trained food safety workers. Compliance rates varied between outcomes (72.67 ± 17.21% to 88.3 ± 18.8%). Compared to Mecca, Madinah FSEs were more adherent to cleanliness (80.5 ± 27.9% vs. 91.5 ± 19.9%, respectively, p = 0.006). FSEs with trained workers were more likely to comply with proper food safety practices compared to those with untrained workers: cleanliness (OR: 7.2, 95% CI [2.6-20.23], p < 0.001); workers' commitment to health requirements (OR: 2.8, 95% CI [1.1-6.9], p = 0.025); handling of refrigerated and frozen food (OR: 5.27, 95% CI [1.83-15.20], p = 0.004); and food storage practices (OR: 12.5, 95% CI [2.0-12.5], p < 0.001). The role of professional training in increasing food safety practices compliance was highlighted. FSEs in Madinah were more compliant with food safety practices than those in Mecca. Therefore, Mecca FSEs may need stringent safety measures.

Development of a food handling practices assessment tool based on the Sri Lanka food regulations.

Objectives: Neither the current assessment tool of Sri Lanka for food establishments is based on prevailing Food Regulations 2011 nor did its focus cover serious adaptions for precautions upon prevention of the diseases. The study aims to develop a food handling practices assessment tool based on the Sri Lanka Food Regulations 2011 and to assess food handling practices using a developed tool in the Regional Director of Health Services area, Kalutara. Methods: The study consisted of developing food establishments' assessment tool (FEAT) in accordance with Food (Hygiene-1742/26) Regulations of Sri Lanka 2011 and assessing the food establishments using the developed tool in the Regional Director of Health Services area, Kalutara, Sri Lanka. The development of FEAT was carried out to mark inspection scores for food establishments conforming to Food Regulations, others reviewed international food safety protocols and agreements following key informant interviews and focus group discussions. Fully developed FEAT was transferred to a mobile application for ease of use, and assessments were conducted among 421 food establishments in three Medical Officer of Health areas. Results: FEAT contained 11 domains including 75 items with more than 100 assessment points including a guide to conducting an assessment of food handling, compared to the current version of the assessment tool in Sri Lanka. The majority of participants included in the qualitative assessment agreed to include a 1-5 scoring scale to report hygiene levels and to use hygiene regulation to develop FEAT as a legal basis. The highest percentage of food establishments (69.4%) in the "Good" category were in the Bandaragama Medical Officer of Health Area and the highest percentage of food establishments (54.5%) in the "very poor" category were in the Walallawita Medical Officer of Health Area. Food establishments taking precautionary measures, which are not assessed in the current tool, were good, but maintenance of processing area and installation of overhead structures and fitting were poor in food establishments in all three Medical Officer of Health Areas. Conclusions: The novel food assessment tool FEAT is a completely valid instrument for food establishments. It is designed for easy administration and supports reliable assessments. Overall food handling practices of food establishments in the Kalutara Regional Director of Health Services area following assessment with FEAT were in the "satisfactory" category.

Sanitary and Hygienic Status and Associated Factors Among Food and Drinking Establishments of Burayu Town, Oromia, Ethiopia.

Background: Foodborne diseases (FBDs) are a major public health concern in both developed and developing countries, as they comprise a broad spectrum of diseases and account for a significant proportion of morbidities and mortalities worldwide. In Ethiopia, the food and drinking establishments contribute to the incidence of foodborne diseases often associated with outbreaks that end up threatening global public health security. Objective: To assess sanitation and hygienic status and associated factors among food and drinking establishments in Burayu town, Oromia, Ethiopia, 2022. Methods: An institution-based cross-sectional study design with a systematic sampling technique was used. Data were collected from 257 food and drinking establishments' managers/owners using questionnaires and observational checklists. Data were entered by Epi data version 3.1 and exported to BIM SPSS version 21 for data analyses. Both descriptive and analytic statistics were employed. Statistical significance was considered at a P value less than 0.05 at a 95% confidence interval. Results: The study revealed that 47.9% of the food and drinking establishments were in poor sanitation and hygienic status. The study showed that male managers (AOR: 9.29, 95% CI: 2.97-21.14), managers less than 40 years old (AOR: 1.24, 95% CI: 1.03-4.36), more than five years services (AOR: 3.66, 95% CI: 1.66-8.07), lack of clean basin (AOR: 2.92, 95% CI: 0.10-11.47), absence of liquid waste drainage system installations (AOR: 3.26, 95% CI: 0.12-0.62) were significantly associated with poor sanitation and hygienic status of food and drinking establishments. Conclusion and Recommendation: The findings indicated that high prevalence of poor sanitation and hygienic status of the food and drinking establishments. Therefore, the establishments should avail waste drainage system, clean basin, renew the establishment providing the service for many years and encourage female empowerment to fulfill and maintain sanitation and hygienic status of their establishments.

Determinants of safe food handling practice among food handlers in food establishments, Yeka sub city, Addis Ababa, Ethiopia.

Background: Poor food handling practice is a key cause of foodborne diseases notably in developing countries like Ethiopia. This study aimed to assess food safety knowledge, attitude and practice of food handlers, establishments' status and determinants of safe food handling practice. Methods: The study utilized institution based cross-sectional study among food handlers working in Cafeterias, Restaurants and Hotels in Yeka sub city, Addis Ababa. A total of 284 food handlers: 69 from Cafeterias, 89 from Restaurants and 126 from non-stared Hotels were enrolled using stratified random sampling technique. Data were collected in observational checklist and through structured-questionnaire via face to face interview. A binary and multivariate logistic regression was used and adjusted for cofounders. A P-value of less than 0.05 was considered statistically significant. Result: The present study has indicated 42.6% of food handlers had good food handling practice. Food handling practice in the establishments were significantly associated with sex, monthly income, availability of functional pipe water supply, availability of soap and/or detergents and presence of insects or rodents. Conclusion: Food handlers in the study area were executing in a poor food handling practice, as most of them were not knowledgeable as needed. In fact, revising the salary of food handlers based on their work load could be valid, as there is existing worldwide economic inflation. Likewise enhancing pipe water availability in the food premises and dispatching sufficient soaps and detergents coupled with eradicating ubiquitous insects and rodents are key.

Food Safety Behaviours among Food Handlers in Different Food Service Establishments in Montenegro.

Foodborne diseases in food facilities are a major public health problem, due mostly to the limited surveillance and educational level of food-handling workers. This study was conducted in 220 food service locations in Montenegro. Participants' behaviour was assessed by a survey using the specifically designed structured questionnaire, administered before and after the training. To determine the effect of the training on the performance of food handlers, a microbiological analysis of food contact surfaces and food handlers' hands was also performed. The behaviour of food handlers, viewed as a whole, is unacceptable. There was a statistically significant difference (<0.05) among participants who completed catering school compared with those who did not, regarding hand washing. The type of facility in which participants worked (restaurant, bakery, or pastry shop) revealed statistically significant differences (<0.05) in relation to hand washing, that is, restaurant employees had better habits than those from bakeries and pastry shops. Before the training, participants showed acceptable behaviour regarding hand hygiene, but it was much better after the training. Results of microbiological analyses of food contact surfaces and food handlers' hands indicated better results after the education, especially with regard to hand swabs. The results of this study indicate the importance of education to improve food handling practices among food handlers, which might also decrease the possibilities for contamination of food.

Frecuencia de y cesáreas en establecimientos públicos y privados de la Provincia de Concepción, Chile, 2001-2019 / Caesareans section frequency in public and private establishments of the Province of Concepción, Chile, 2001-2019

Introducción: El porcentaje nacional de cesárea supera las recomendaciones internacionales, alcanzando altos niveles, con consecuencias significativas en la salud de la mujer. Por esta razón es un problema necesario de analizar. Objetivo: Describir la situación epidemiológica de las cesáreas en la Provincia de Concepción, periodo 2001-2019, según establecimiento y previsión. Material y métodos: Estudio observacional, descriptivo, ecológico, transversal. Incluye universo de partos en la Provincia de Concepción 2001-2019, datos del Departamento de Estadísticas e Información de Salud (DEIS). Recopilación y análisis según técnicas descriptivas en Microsoft Excel® Resultados: En establecimientos públicos, el número de partos disminuyó un 60.6%. En establecimientos privados aumentó 4.8 veces, junto al 39% de incremento en las cesáreas. Las pacientes pertenecientes al grupo A de menores ingresos de la aseguradora de salud pública, Fondo Nacional de Salud (FONASA), presentaron un porcentaje estable de cesáreas, en torno al 25%, mientras que el grupo D (de mayores ingresos) aumentó un 47.8% entre los años 2005 y 2009. Entre 2002 y 2019 el porcentaje promedio de cesáreas de pacientes pertenecientes a las aseguradoras privadas, Instituciones de Salud Previsional (ISAPRE), fue del 66.5%. Conclusiones: Se observó un aumento de cesáreas muy especialmente en recintos privados. La previsión de salud es un factor que considerar, particularmente el grupo FONASA-D, que presentó la mayor alza en las cesáreas, incluso más que las gestantes de ISAPRE. El porcentaje alarmante de cesáreas, especialmente en establecimientos privados, debe ser preocupación prioritaria para nuestro sistema de salud.

Introduction: The national caesarean section rate exceeds international recommendations, reaching elevated levels, with significant consequences on women's health. For this reason it is a necessary problem to analyze. Objective: To describe the epidemiological situation of caesarean sections in the Province of Concepción, period 2001-2019, according to establishment and forecast. Material and methods: Observational, descriptive, ecological, longitudinal study. Includes universe of births in the Province of Concepción 2001-2019, data from the Department of Statistics and Health Information (DEIS). Collection and analysis according to descriptive techniques in Microsoft Excel®. Results: In public establishments, the number of deliveries decreased by 60.6%. In private establishments it increased 4.8 times, together with the 39% increase in cesarean sections. Patients belonging to group A with the lowest income of the public health insurer, National Health Fund (FONASA), presented a stable percentage of caesarean sections, around 25%, while group D (with the highest income) increased 47.8% between 2005 and 2009. Between 2002 and 2019, the average percentage of caesarean sections of patients belonging to private insurers, Institutions of Social Security (ISAPRE), was 66.5%. Conclusions: An increase in caesarean sections was observed, especially in private facilities. Health insurance is a factor to consider, particularly the FONASA-D group, which presented the highest increase in cesarean sections, even more than ISAPRE pregnant women. The alarming percentage of caesarean sections, especially in private establishments, should be a priority concern for our health system.

Report on the GHPP-BloodTrain online workshop on "Authorisation and Licensing of Blood Establishments - Review of quality documentation of blood and blood components", 5th-8th of July 2021.

The GHPP BloodTrain team developed an e-learning concept in response to the COVID-19 travel restrictions, providing training formats with virtual stages that can be completed during the pandemic (and beyond) and on-site stages, where practical exercises and case reports in smaller groups can lead to a deeper understanding of the content. The virtual training workshop on "Authorisation and Licensing of Blood Establishments", hosted by the PEI GHPP BloodTrain from the 5th to the 8th of July 2021, was the first application of this concept. The number of participants could be substantially increased compared to an on-site event thanks to the virtual setting. Participants came mainly from national regulatory authorities and national blood transfusion services. There were also some Ministry of Health representatives from 19 countries from the WHO regions of AFRO, EMRO, and from Indonesia in attendance. The virtual workshop focused on reviewing and evaluating the quality documentation required for approval of processes used by blood establishments to prepare blood components. Presentations were given by members of the GHPP BloodTrain team as well as by representatives of the German Red Cross. The program was complemented by contributions from the WHO HQ and presentations on country-specific experiences from Ghana and Zimbabwe.

Contaminação parasitária em hortaliças comercializadas no município de Jataí-GO / Parasitic contamination in vegetables commercialized in the city of Jataí-GO

Introdução: a prevalência de doenças parasitárias transmitidas por alimentos tem apresentado um aumento significativo em nível mundial, destacando principalmente as hortaliças, consumidas in natura, em razão da sociedade moderna que procura hábitos de vida mais saudáveis. Objetivo:avaliar a contaminação de hortaliças comercializadas no município de Jataí, GO, por enteroparasitos. Metodologia: foi realizada uma pesquisa experimental para detecção de estruturas parasitárias em hortaliças de cultivo tradicional e hidropônico, obtidas de nove estabelecimentos: três supermercados, três hortas e três feiras livres. Foram obtidas 54 amostras de alface (Lactuca sativa), 54 de rúcula (Chicarium sp.) e 18 de agrião (Nasturtiumofficinale). As amostras foram lavadas com água destilada e solução Tween 80 e submetidas as técnicas de sedimentação espontânea e por centrifugação. Foi realizado um mapeamento da área de estudo para identificação da localização dos estabelecimentos. Resultados: a positividade para estruturas parasitárias foi de 94,4% (119/126). A alface apresentou maior prevalência de parasitos 96,2% (52/54). Foi observada diferença estatística significativa ao comparar o emprego das duas técnicas (p < 0,05). Ashortaliças submetidas a técnica de sedimentação espontânea apresentaram maior positividade 115/126 (91,3%). Não foi observada diferença estatística significante quanto ao tipo de cultivo, porém, houve forte associação em relação ao local de cultivo e contaminação das hortaliças (OR: 3,625). Verificou-se maior percentual de positividade nos estabelecimentos localizados próximos aos rios. Conclusão: a positividade de enteroparasitos detectada nas hortaliças foi alta, ressaltando a necessidade de implementar medidas que visam a conscientização da população, em relação às práticas de higienização das hortaliças antes do consumo.

Introduction: the prevalence of parasitic diseases transmitted by food has shown a significant increase worldwide, especially vegetables, consumed in natura, due to modern society that seeks healthier lifestyles. Objective: to evaluate the contamination of vegetables commercialized in the city of Jataí, GO, by enteroparasites. Methodology: an experimental research was carried out to detect parasitic structures in vegetables of traditional and hydroponic cultivation, obtained from nine establishments: three supermarkets, three vegetable gardens and three street markets. Fifty four samples of lettuce (Lactuca sativa), 54 of arugula (Chicarium sp.) and 18 of watercress (Nasturtium officinale) were obtained. The samples were washed with distilled water and Tween 80 solution and submitted to spontaneous sedimentation and centrifugation techniques. A mapping of the study area was carried out to identify the location of the establishments. Results: positivity for parasitic structures was 94.4% (119/126). Lettuce had a higher prevalence of parasites 96.2% (52/54). A statistically significant difference was observed when comparing the use of the two techniques (p < 0.05). Vegetables submitted to the spontaneous sedimentation technique showed higher positivity 115/126 (91.3%). There was no statistically significant difference regarding the type of cultivation, however, there was a strong association in relation to the place of cultivation and contamination of vegetables (OR: 3.625). There was a higher percentage of positivity in establishments located near the rivers. Conclusion: the positivity of intestinal parasites detected in vegetables was high, highlighting the need to implement measures aimed at raising awareness of the population regarding the practices of cleaning vegetables before consumption.

Relationship between ATP Bioluminescence Measurements and Microbial Assessments in Studies Conducted in Food Establishments: A Systematic Literature Review and Meta-Analysis.

ABSTRACT: Adherence to proper environmental cleaning practices is critical in food establishments. To validate cleanliness, cleaning practices should be routinely monitored, preferably by a rapid, reliable, and cost-effective method. The aim of this study was to determine whether a correlation exists between ATP bioluminescence measurements and selected microbial assessments in studies conducted in food establishments. A systematic literature review and meta-analysis was conducted using the principles of preferred reporting items for systematic reviews and meta-analyses. Twelve online databases and search engines were selected for the review. Peer-reviewed articles published in English between January 2000 and July 2020 were included in the search. From a total of 19 eligible studies, 3 that included Pearson correlation coefficients (r) between ATP bioluminescence measurements and microbial assessments were used for the meta-analysis calculations. Only the fixed-effect model produced a strong correlation because one value dominated the estimates: r = 0.9339 (0.9278, 0.9399). In contrast, both the random effects model, 0.2978 (0.24, 0.3471), and the mixed effects model, r = 0.3162 (-0.0387, 0.6711), indicated a weak relationship between ATP bioluminescence and microbial assessments, with no evidence of a strong correlation. The meta-analysis results indicated no sufficient evidence of a strong correlation between ATP bioluminescence measurements and microbial assessments when applied within food establishments. This lack of evidence for a strong correlation between the results of these two monitoring tools suggests that food establishments cannot depend on only one method. Yet, with immediate feedback and quantification of organic soiling, ATP bioluminescence could be an effective monitoring tool to use in food establishments.

Healthcare performance management using integrated FUCOM-MARCOS approach: The case of India.

AIMS: The goal of this research is to propose a simpler and more efficient model for evaluating healthcare establishments (HCEs). With this motivation, this study aims to discover key performance indicators (KPIs) that affect HCE performance, present a ranking model for KPIs in Indian HCEs, and evaluate Indian HCEs using the identified and prioritised KPIs. MATERIAL AND METHODS: Through extensive literature review and expert opinions, this research identifies the various KPIs in HCEs, classifies them into six main categories, and prioritises them using the full consistency method (FUCOM). Further, well-known HCEs across northern India were evaluated and ranked using Measurement Alternatives and Ranking according to Compromise Solution. RESULTS: The 'technology adoption related indicators' is found as the most important main KPIs, whereas 'adequate number of hospital beds and bathrooms (IE5)' as the most dominating sub-category KPIs. Also, amongst the 20 evaluated Indian HCEs 'healthcare establishment-1 (HCE1)' was found to be the best performing HCE while 'healthcare establishment-12 (HCE12)' was found to be the worst-performing HCE. The stability and consistency of the results are ascertained by performing sensitivity analysis and comparing the results with other existing methodologies. CONCLUSION: The findings of this study are quite important for HCEs management to fully comprehend the key areas to improve upon so that managers can improve medical standards in a targeted manner. The developed prioritisation model and methodology shown in this paper will help and motivate managers and intellectuals of HCEs to evaluate and improve the HCE's performance.

Consumer perspectives on the inclusion of nutritional warnings in retail food establishments

ABSTRACT The present work aimed to assess Uruguayan consumers support of the inclusion of nutritional warnings on four types of retail food establishments and to obtain consumer insights on how the warnings could be implemented in such establishments. For this purpose, an online survey was conducted with a non-probabilistic sample of 547 participants recruited via an advertisement on social media. Participants were requested to indicate their degree of agreement with the implementation of nutritional warnings in bakeries, delicatessens, fast-food restaurants and while ordering food online, and to provide ideas on how to include this information for each establishment. Results suggested that the inclusion of nutritional warnings in retail food establishments was positively perceived by participants. Participants highlighted that warnings should be highly visible to customers while making purchase decisions, so they become a relevant cue for making food choices. In particular, the retail display case and menu boards were identified as key locations for warnings in bakeries, delicatessen, and fast food restaurants, respectively. These results contribute valuable insights on how to implement the extension of nutritional warnings to unpackaged foods or foods made and packaged at the point of purchase.

RESUMEN El presente trabajo tuvo como objetivo evaluar la percepción de los consumidores uruguayos en relación a la implementación de advertencias nutricionales en cuatro puntos de venta de comida y generar ideas sobre cómo podría implementarse esta medida. Se realizó un estudio online con una muestra no probabilística de 547 participantes, reclutados utilizando publicidad en redes sociales. Los participantes indicaron su grado de acuerdo con la implementación de advertencias nutricionales en panaderías, rotiserías, lugares de venta de comida rápida y sitios de pedidos online, y proporcionaron ideas sobre cómo incluir esta inforamción en cada punto de venta. Los resultados sugieren que la población tiene una perecpeción positiva sobre la inclusión de advertencias nutricionales en puntos de venta de comida. Los participantes destacaron la importancia de incluir esta información en un lugar visible al momento de elegir los productos, de forma que pueda ser tenida en cuenta al tomar las decisiones. En particular, las vitrinas y la cartelería/pizarras fueron identificados como lugares estatégicos para la inclusión de advertencias nutricionales en panaderías/rotiserías y puntos de venta de comida rápida, respectivamente. Los resultados proporcionan valiosa información para extender la inclusión de advertencias nutricionales a puntos de venta de comida.

Natural Observation of Alcohol Price and Promotions at Bars: Implications for Alcohol Misuse Prevention.

Alcohol misuse among young adults remains a primary public health concern given the wide range of short- and long-term physical, social, and societal consequences of the behavior. On-premise drinking establishments, which allow alcohol consumption on site (i.e., bars), are frequent locations for young adult alcohol use. Risks for alcohol misuse within the bar setting are key factors to identify for prevention. Notably, alcohol price and promotions are associated with alcohol consumption among young adults. This study sought to develop and pilot test an observational protocol to assess the alcohol environment at on-premise drinking establishments. Following qualitative exploration of salient risk factors in these settings through focus groups with young adults, an observational tool was adapted and tested in a feasibility study. The refined tool was then pilot tested with two independent data collectors conducting natural observation at 13 establishments in the downtown nightlife district of a small, southeastern city. High interrater reliability was noted. Descriptive summary statistics of bar characteristics demonstrate low alcohol prices with variability across types of alcohol (e.g., beer, wine, and liquor), greater numbers of alcohol promotions inside rather than outside the building, and higher rates of manual versus electronic age verification procedures. Observational assessment of alcohol price and marketing at on-premise drinking establishments as described in this study is needed to inform prevention policy and programs to reduce harms associated with young adult alcohol misuse.

Food handling practices and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia.

INTRODUCTION: foodborne disease (FBD) is a major public health problem globally. Inadequate food workers' knowledge, attitude, and low level of food handling practices (FHPs) may all contribute to the possibility of FBD outbreaks in public food service establishments. This study aimed to assess FHPs and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia. METHODS: an institutional-based cross-sectional study was conducted from 01 to 29, January 2017. A total of 288 food handlers were recruited through a simple random selection method. A structured interviewer-administered questionnaire and observation checklists were used to collect the respondents' socio-demographic characteristics, knowledge status on FHPs, and food handling working practices data. Descriptive statistics, bivariate and multivariate logistic regression analysis were employed using SPSS version 20 software. Those variables with a p< 0.05 were considered statistically significant. RESULTS: out of 288 participants, 91.7% were female, and 82.3% were single, while 69.8% were literate. One hundred eighty-four (63.9%) of them were under 15-25 years of age, with a median age of 23.3 years. The proportion of good FHP was (n=134, 46.5%) (95% CI: 41.00-52.4%). Advanced age (adjusted odds ratio (AOR) =12.01, 95% CI: 1.96-73.52), education (participants who attend grades 7-12 (AOR=2.33, 95% CI: 1.14-4.79), and above secondary education (AOR=2.29, 95% CI: 1.05-4.61), work experience above six years (AOR=2.43, 95% CI: 2.08-3.17), received formal training (AOR=1.79, 95% CI: 1.68-4.71), and inspection visits by a concerned body (AOR=2.24, 95% CI: 1.05-3.09) were factors positively associated with handling practices. CONCLUSION: the study revealed that FHP in the study area was low. Age, education, service year, training received and sanitary inspection visits by the regulatory personnel were factors significantly associated with FHPs. This finding highlights the importance of employing regular sanitary inspection visits to public food service establishments by the concerned authority to ensure that all food handlers have the knowledge and the skill to provide safe food.