EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

The objective of this study was to survey experts concerning consumer behaviors most likely to reduce the risk of illness caused by 13 food pathogens.

Inclusion Criteria:

Nationally-known experts on food safety (nine epidemiologists, 11 food microbiologists, 10 food safety educators and 10 policy makers).

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

40 nationally-known experts on food safety (nine epidemiologists, 11 food microbiologists, 10 food safety educators and 10 policy makers) were recruited to participate in the study.

Design

Cross-sectional study.

Statistical Analysis

Data were collected from the Web page input forms, converted to text files compatible with spreadsheet software and summarized
A mean rank score for each behavior associated with a pathogen was calculated by averaging the rankings given to that behavior by the respondents
The rank order of the behaviors associated with each pathogen was derived from the order of the mean rank scores with the most important behavior for that pathogen having the mean rank score closest to one.

Data Collection Summary:

Timing of Measurements

In preparation for the Delphi process, a literature search was conducted to construct lists of food-handling behaviors associated with each of the pathogens included in the study. 30 behaviors were identified as being important for the control of one or more of the 13 pathogens
In Round One, Delphi respondents logged onto a website and were presented with the unedited lists of food handling behaviors for each pathogen
In Round Three, the focus was on the classification of food-handling behaviors into five pathogen control factors: Personal hygiene, the adequate cooking of foods, the avoidance of cross contamination, the maintenance of foods at safe temperatures and the avoidance of foods from unsafe sources
For Round Four, the researchers reduced the number of behaviors to 40 on the basis of the respondents' input from the previous round.

Dependent Variables

Illness due to food pathogens.

Independent Variables

13 pathogens were selected for the Delphi process. Each of the pathogens were selected as implicated in over 1,000 cases of illness per year and at least 20% of those cases were considered foodborne.

Description of Actual Data Sample:

Initial N: 40 experts on food safety (nine epidemiologists, 11 food microbiologists, 10 food safety educators and 10 policy makers)
Attrition (final N): 40 experts on food safety (nine epidemiologists, 11 food microbiologists, 10 food safety educators and 10 policy makers)
Age: Not reported
Ethnicity: Not reported
Other relevant demographics: 30 food-handling behaviors for each pathogen was identified through the Delphi process
Anthropometrics: Not reported
Location: Washington State University, Washington.

Summary of Results:

Key Findings

For six of the pathogens, control was primarily associated with food-handling behaviors related to adequate cooking or the avoidance of cross-contamination. These pathogens are zoonotic pathogens that can be transmitted from animals to humans.
The food safety experts ranked behaviors related to keeping food at safe temperatures as of primary importance in preventing illness caused by Bacillus cereus and Clostridium perfringens and of secondary importance in preventing illness caused by Staphylococcus aureus
The use of a thermometer to cook foods adequately was ranked as of primary importance for the prevention of illness caused by Campylobacter jejuni, Salmonella species, Escherichia coli O157:H7, Toxoplasma gondii and Yersinia enterocolitica, with the avoidance of cross-contamination being ranked as of secondary importance for most of these pathogens
The avoidance of foods that have been associated with infections caused by E. coli 0157:H7 and Salmonella enteritidis was ranked as one of the top two behaviors for each of these pathogens
Two pathogens considered in the present study emanate from the human intestine, thus human fecal contamination of water or food is a source of these pathogens
Three of the five behaviors for the prevention of Shigella infections were associated with personal hygiene: Hand-washing was the top-ranked behavior for preventing shigellosis
The avoidance of certain foods that are likely to be contaminated was the top-ranked behavior for the prevention of illnesses caused by Listeria monocytogenes, Noroviruses and Vibrio species.

Author Conclusion:

The expert panel's ranking of behaviors for the reduction of the risk of illness caused by major foodborne pathogens can enable consumers to make informed choices about food consumption and handling behaviors and can guide food safety educators in prioritizing their educational efforts
As changes in the prevalence of foodborne pathogens occur, there is a need for continual re-examination of the guidance that is provided to consumers. Convening a panel of experts to respond to information presented sequentially via the World Wide Web is a cost-effective way to update guidance as new data become available and new pathogens are recognized.

Funding Source:

Government:

USDA-CSREES National Research Initiative grant no. 99-34201812

Reviewer Comments:

Inclusion and exclusion criteria were not well-described for an expert panel
Expert panelists were not well-described
A couple of limitations regarding the Delphi technique were noted: First, the results are not valid unless the panel of experts reflects the full range of opinions of the subject at hand; second, the Web pages require respondents to respond in fixed ways.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	No
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	N/A
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	N/A
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes