Perceptions of oral health by those living with mental illnesses in the Victorian Community - The consumer's perspective.

OBJECTIVE: To understand the way people living with mental illness in an Australian community experience and define oral health. STUDY POPULATION: People living with serious mental illness in the Victorian Community. METHODS: Qualitative methodologies were used in this study. Two focus groups and four semi-structured interviews were conducted. The data were transcribed and thematically analysed. RESULTS: Participants generally valued oral health and recognized that attending regular dental appointments played a key role in improving their oral health. Participants felt that their mental illness overwhelmed their ability to maintain good oral health. Coping, dental fear, stigma, financial barriers and communication were identified as issues around utilization and access to care. DISCUSSION: Experiences of oral health were both positive and negative. Barriers and enablers, extending beyond participant oral health literacy for oral health, were identified from the data, and recommendations around personal, environmental and clinical supports were made. CONCLUSION: This is a valuable study that provides new insight into a complicated issue. Recommendations to create a supportive dental environment and direction to improve the dental experience have been made to make oral health more accessible for people living with mental illness. Recommendations have also been made for community-based mental health organizations to aid the improvements in oral health with this group of people, thus building a collaborative approach to support oral health for this vulnerable group.

Noise levels in dental school clinics.

UNLABELLED: Prolonged exposure to noise is a little-investigated occupational hazard in dentistry. There is anecdotal evidence suggesting that noise levels in four student clinics at the School of Dentistry are higher than the current occupational noise level guidelines in New Zealand, Australia and the United Kingdom, which suggest that levels should not exceed 85 dB (A) over a duration of 8 hours. The objectives of this study were to (1) measure the noise levels in the student clinics, and (2) determine whether they exceed current guidelines for occupational noise levels. METHOD: A noise level meter was used to measure the decibel recordings in dB (A), before and during clinical sessions. The types of procedures being carried out by the students were recorded. RESULTS: 127 background recordings and 126 activity recordings were made, with measured noise levels ranging from 50.2 to 77.6 dB (A) for background levels, and 51.4 to 98.0 dB (A) during activity, with means of 60.8 and 70.5 dB (A) respectively. Measurements made in one clinic (the 4SW clinic) were significantly higher than those made in the other clinics (P < 0.001), and one (clinic 2N) gave the lowest readings. CONCLUSION: Noise levels recorded from the clinics at the Otago School of Dentistry exceed those specified in the current New Zealand Occupational Health and Safety guidelines, but they are intermittent rather than continuous.

Variation in the annual unsatisfactory rates of selected pathogens and indicators in ready-to-eat food sampled from the point of sale or service in Wales, United Kingdom.

The Welsh Food Microbiological Forum "shopping basket" survey is a long running, structured surveillance program examining ready-to-eat food randomly sampled from the point of sale or service in Wales, United Kingdom. The annual unsatisfactory rates for selected indicators and pathogens for 1998 through 2008 were examined. All the annual unsatisfactory rates for the selected pathogens were <0.5%, and no pattern with the annual rate was observed. There was also no discernible trend observed for the annual rates of Listeria spp. (not moncytogenes), with all rates <0.5%. However, there was a trend observed for Esherichia coli, with a decrease in rate between 1998 and 2003, rapid in the first few years, and then a gradual increase in rate up to 2008. It was concluded that there was no discernible pattern to the annual unsatisfactory rates for Listeria spp. (not monocytogenes), L. monocytogenes, Staphylococcus aureus, and Bacillus cereus, but that a definite trend had been observed for E. coli.

EBT2 radiochromic film for quality assurance of complex IMRT treatments of the prostate: micro-collimated IMRT, RapidArc, and TomoTherapy.

In response to the clinical need for a dosimetry system with both high resolution and minimal angular dependence, this study demonstrates the utility of Gafchromic EBT2 radiochromic dosimetry film for the quality assurance of micro-collimated IMRT, RapidArc and TomoTherapy treatments. Firstly, preliminary measurements indicated that the dose response of EBT2 film does not appreciably vary with either the angle of incidence of the radiation beam or the depth in water at which the film is placed. Secondly, prostate treatment plans designed for delivery using static-beam IMRT (collimated using the BrainLab m3 microMLC), RapidArc and TomoTherapy were investigated by comparing dose planes obtained from treatment planning calculations with EBT2 film measurements. For all treatment plans, the proportion of dose points agreeing with the film measurements to within γ (3%,3 mm) was found to be above 95%, with all points agreeing within 5%. The film images provided sufficient information to verify that the treatments could be delivered with an acceptable level of accuracy, while also providing additional information on low-level dose variations that were not predicted by the treatment planning systems. This information included: the location and extent of dose from inter-leaf leakage (in the RapidArc plan) and helical field junctioning (in the TomoTherapy plan), as well as the existence of small regions where the treatment planning system under-predicted the dose from very small treatment segments (in the micro-collimated IMRT plan).

Prevalence of Listeria monocytogenes in ready-to-eat foods sampled from the point of sale in Wales, United Kingdom.

A survey of Listeria in ready-to-eat food took place in Wales, United Kingdom, between February 2008 and January 2009. In total, 5,840 samples were taken and examined for the presence of Listeria species, including L. monocytogenes. Samples were tested using detection and enumeration methods, and the results were compared with current United Kingdom guidelines for the microbiological quality of ready-to-eat foods. The majority of samples were negative for Listeria by both direct plating and enriched culture. Seventeen samples (0.29%) had countable levels of Listeria species (other than L. monocytogenes), and another 11 samples (0.19%) had countable levels of L. monocytogenes. Nine samples (0.15%) were unsatisfactory or potentially hazardous when compared with United Kingdom guideline limits; six (0.10%) were in the unsatisfactory category (>100 CFU/g) for Listeria species (other than L. monocytogenes), and three (0.05%) were in the unacceptable or potentially hazardous category (>100 CFU/g) for L. monocytogenes. All three of these samples were from sandwiches (two chicken sandwiches and one ham-and-cheese sandwich). The most commonly isolated serotype of L. monocytogenes was 1/2a. This survey was used to determine the current prevalence of Listeria species and L. monocytogenes in ready-to-eat foods sampled from the point of sale in Wales.

Assessment of the microbiological safety of salad vegetables and sauces from kebab take-away restaurants in the United Kingdom.

The purpose of this study was to establish the microbiological safety of salad vegetables and sauces served in kebab take-away restaurants. Comparison with published microbiological guidelines revealed that 4.7% of 1213 salad vegetable samples were of unsatisfactory microbiological quality due to Escherichia coli and/or Staphylococcus aureus levels at > or =10(2) cfu g(-1). Another 0.3% of salad samples were of unacceptable quality due to S. aureus at > or =10(4) cfu g(-1) (2 samples) or the presence of Salmonella Kentucky (1 sample). Cucumber was the most contaminated salad vegetable with regards to unsatisfactory levels of E. coli (6.0%) or S. aureus (4.5%). Five percent of 1208 sauce samples were of unsatisfactory microbiological quality due to E. coli, S. aureus at > or =10(2) cfu g(-1) and/or Bacillus cereus and other Bacillus spp. at > or =10(4) cfu g(-1). A further 0.6% of sauce samples were of unacceptable quality due to Bacillus spp. (Bacillus subtilis, Bacillus pumilus, Bacillus licheniformis) at > or =10(5) cfu g(-1) or the presence of Salmonella Agbeni (1 sample). More samples of chili sauce (8.7%) were of unsatisfactory or unacceptable microbiological quality than any other sauce types. The results emphasize the need for good hygiene practices in kebab take-away restaurants handling these types of ready-to-eat products.

Microbiological quality of ready-to-eat food served in schools in Wales, United Kingdom.

A survey of the general microbiological quality of ready-to-eat food served in schools was undertaken across Wales, United Kingdom. Of the 2,351 samples taken, four were identified as containing unsatisfactory counts of Escherichia coli, four contained unsatisfactory counts of Staphylococcus aureus, and one contained an unacceptable count of Bacillus cereus when compared with guidelines for the microbiological quality of ready-to-eat food published by the United Kingdom Public Health Laboratory Service in 2000. No samples contained detectable levels of Salmonella, Listeria species, or Clostridium perfringens. When compared with data on the general microbiological quality of food available in Wales, the food sampled from schools was of relatively better microbiological quality.

Survey of Salmonella contamination of raw shell eggs used in food service premises in the United Kingdom, 2005 through 2006.

This survey was launched after an unusual number of Salmonella Enteritidis outbreaks associated with the use of eggs in food service premises in England and Wales. Between November 2005 and December 2006, 9,528 eggs (1,588 pooled samples of 6 eggs) were collected from 1,567 food service premises in the United Kingdom, most of which (89%) were produced in the United Kingdom. Salmonella was isolated from 6 (0.38%) pools of eggs. Of these, 5 (0.31%) were Salmonella Enteritidis, which were further characterized to phage types (PTs): PT 4 (0.19%), PT 8 (0.06%), and PT 12 (0.06%). Salmonella Mbandaka was also isolated (0.06%). Salmonella was detected from five and one of pooled eggs samples that were produced in the United Kingdom and Germany, respectively; these were from different producers. The study showed evidence of poor egg storage and handling practices in food service premises, in that 55% did not store eggs under refrigerated conditions; 20.7% of eggs had expired "best before" dates or were in use after 3 weeks of lay, indicating poor stock rotation; and 37.1% pooled eggs not intended for immediate service. Eggs are a commonly consumed food that may occasionally be contaminated with Salmonella at different rates, according to their country of origin. The food service sector needs to be aware of this continuing hazard, receive appropriate food safety and hygiene training on storage and usage of raw shell eggs, adopt appropriate control measures, and follow advice provided by national food agencies in order to reduce the risk of infection.

Occurrence of Listeria monocytogenes in sandwiches available to hospital patients in Wales, United Kingdom.

A survey for the presence of Listeria monocytogenes in hospital sandwiches was carried out in Wales, United Kingdom, between October 2005 and March 2006. The main aim of the survey was to establish the baseline rate of L. monocytogenes in hospital sandwiches after an outbreak of listeriosis among hospital patients in 2004 was epidemiologically linked to the consumption of contaminated sandwiches. The overall positive rate found in hospital sandwiches was 2.84% for enriched culture and 0.21% for direct counts. The unsatisfactory rate (> 100 CFU/g) for hospital sandwiches was 0.1%. The conclusion was that hospital sandwiches generally presented a low hazard to consumers. In addition to establishing the overall baseline and the unsatisfactory rates in hospital sandwiches in Wales for this period, the study compared the rates found in hospital sandwiches with the rates found in sandwiches simultaneously sampled from general retailers. The aim of this part of the study was to compare the relative rates associated with hospital and retail sandwiches to ascertain if there were any differences in the positive rate. The conclusion of this part of the survey was that there was not a statistically significant difference in rates between sandwiches sampled from hospitals and those sampled from general retailers.

Three-year surveillance program examining the prevalence of Campylobacter and Salmonella in whole retail raw chicken.

A 36-month study of Campylobacter and Salmonella in retail raw whole chicken was carried out to measure baseline rates at the retail level, establish seasonality, and observe changes in rates over time. In total, 2,228 samples were taken between November 2001 and December 2004. The Campylobacter rate was unchanged over the 3 years of the study, but the Salmonella rates declined significantly between 2001 and 2004. There was also some seasonality in Campylobacter rates in fresh samples. The overall conclusion from the study was that the Salmonella rate in raw chicken available to consumers in Wales fell significantly between 2001 and 2004, while the Campylobacter rate remained unchanged and is still by far the greater problem.

Microbiological quality of randomly selected ready-to-eat foods sampled between 2003 and 2005 in Wales, UK.

Since 1995, the publicly funded ready-to-eat food sampling and examination activities in Wales have been coordinated and structured, using a novel approach for the identification of samples and premises. The latest set of data from this surveillance system reports the results from 3391 ready-to-eat foods sampled between November 2003 and March 2005. During this seventeen-month period all samples were examined for aerobic colony count, Escherichia coli, Listeria spp., Bacillus cereus, Salmonella, Staphylococcus aureus and Listeria monocytogenes. The food types with the poorest microbiological quality were cream cakes, custard slices and egg mayonnaise sandwiches. The food type with the best microbiological quality was dried fruit. In conclusion, the results indicate that, in general terms, the ready-to-eat food types sampled and examined in this period posed little bacterial hazard to consumers.

Survey of Salmonella and Campylobacter contamination of whole, raw poultry on retail sale in Wales in 2003.

A survey of the Salmonella and Campylobacter contamination of raw, whole chickens available to consumers in Wales was performed between March and December 2003. In total, 736 samples were taken, and overall contamination rates of 73.1% for Campylobacter and 5.7% for Salmonella were found. This survey follows a survey performed during 2001 to 2002 by Welsh local authorities and the National Public Health Service for Wales that established updated baseline rates for both pathogens in raw, whole chicken available to consumers in Wales. This survey indicated no difference in Campylobacter rates between fresh and frozen samples or between samples taken from retailers and local butchers, but significant differences existed in Salmonella rates between fresh and frozen samples and between those sampled from retailers and butchers, with frozen chickens and samples taken from retailers having significantly higher rates. However, the difference in Salmonella isolation rate between retailers and butchers was found to be due to the differences in the proportions of fresh and frozen chickens sampled from these locations, with a significantly higher number of frozen chickens (with a higher Salmonella rate) being sampled from retailers.

The seasonality of human campylobacter infection and Campylobacter isolates from fresh, retail chicken in Wales.

Seasonal peaks in both human campylobacter infections and poultry isolates have been observed in several European countries but remain unexplained. We compared weekly data on human campylobacter infections with thermophilic Campylobacter isolation rates from fresh, retail chicken samples (n = 514) purchased weekly in Wales between January and December 2002. Human isolates (n = 2631) peaked between weeks 22 and 25 (early June) and chicken isolates (n = 364) between weeks 24 and 26 (late June). In the absence of a temporal association, we postulate that the seasonal rise in humans is not caused by a rise in isolation rates in poultry but that both are more likely to be associated with a common, but as yet unidentified, environmental source.

Microbiological quality of ready-to-eat foods: results from a long-term surveillance program (1995 through 2003).

The coordination of food sampling activities across Wales, a part of the United Kingdom with a population of approximately 3 million, led to the establishment in 1995 of a coordinated food-sampling program designed to monitor on a long-term basis the microbiological quality and safety of specific ready-to-eat products. This surveillance system has been ongoing for 9 years and has generated a database of microbiological and associated demographic results for 15,228 ready-to-eat food samples. The food types that had the poorest overall results were sliced meats, unsliced poultry, sandwiches made without salad, and cakes made without dairy cream. For all food types, the overall unsatisfactory rate was 17% for aerobic colony counts, 1.6% for Escherichia coli, and 0.5% for Listeria spp. Overall unsatisfactory or unacceptable rates for pathogens such as Clostridium perfringens, Listeria monocytogenes, Bacillus cereus, and Staphylococcus aureus were all below 0.5%. No Campylobacter-positive samples and only one Salmonella-positive sample were found. The analysis of the results show that the ready-to-eat food types sampled over the 9 years of the program were generally of good microbiological quality when compared with current United Kingdom guidelines. The information contained in the database provides a baseline measurement of the microbial quality of a variety of ready-to-eat foods and allows environmental health officers and food microbiologists to generate hypotheses for targeted surveys or research work.

Enhancement of data collection from Welsh 'shopping basket' ready-to-eat food surveillance programme.

The method of data collection from the Welsh 'shopping basket' ready-to-eat food sampling programme has recently been reviewed, with the principal aim of reducing the resources required for inputting and audit of data. The subsequent improvements made have been primarily software based and they have made data collection, audit and analysis significantly faster and more efficient.

Baseline rates of Campylobacter and Salmonella in raw chicken in Wales, United Kingdom, in 2002.

The Public Health Laboratory Service in Wales, in cooperation with local authorities and the Food Standards Agency Wales, carried out a survey to establish baseline figures for the contamination of raw retail chicken with Salmonella and Campylobacter available within Wales, a devolved part of the United Kingdom with a population of approximately 3 million. Seven hundred thirty-nine samples were obtained between November 2001 and December 2002. Overall, 71% of samples were contaminated with Campylobacter, and 8% were contaminated with Salmonella. There were no significant differences between fresh and frozen carcasses and between samples taken from retailers or butchers. There was seasonal variation in the level of Campylobacter contamination of fresh chicken, with a peak in June and the lowest positive rates in January, March, and December. There was no similar peak observed in frozen samples or for Salmonella.

Gap junction communication dynamics and bystander effects from ultrasoft X-rays.

Gap junctions provide a route for small molecules to pass directly between cells. Toxic species may spread through junctions into 'bystander' cells, which may be exploited in chemotherapy and radiotherapy. However, this may be prevented by junction closure, and therefore an understanding of the dose-dependency of inhibition of communication and bystander effects is important. Low-energy ionising radiation (ultrasoft X-rays) provides a tool for the study of bystander effects because the area of exposure may be carefully controlled, and thus target cells may be clearly defined. Loss of gap junction-mediated intercellular communication between irradiated cells was dose-dependent, indicating that closure of junctions is proportional to dose. Closure was associated with hyperphosphorylation of connexin43. Inhibition of communication occurred in bystander cells but was not proportional to dose. Inhibition of communication at higher radiation doses may restrict the spread of inhibitory factors, thus protecting bystander cells. The reduction in communication that takes place in bystander cells was dependent on cells being in physical contact, and not on the release of signalling factors into the medium.

Campylobacter in ready-to-eat foods: the result of a 15-month survey.

Ready-to-eat foods at retail and catering establishments were randomly sampled at the point of sale for a period of 15 months. During this period, 4,469 food samples were examined for the presence of Campylobacter with the use of plate-based methodology. A range of different ready-to-eat food types, all of which have the potential to be contaminated with the organism, were examined. No viable Campylobacter cells were detected in any of the foods during the survey. There is no evidence that the foods examined in this study represent a risk to the consumer. Although these foods may be a vehicle for infection if cross-contamination occurs, other sources need to be investigated as causes of enteric infection caused by Campylobacter.

An outbreak of viral gastroenteritis following environmental contamination at a concert hall.

In January 1999, an outbreak of viral gastroenteritis affected more than 300 people who attended a metropolitan concert hall over a 5-day period. Norwalk-like virus (NLV) was confirmed in faecal samples by reverse transcription polymerase chain reaction assay. The index case was a concert attendee who vomited in the auditorium and adjacent male toilet. Gastrointestinal illness occurred among members of 8/15 school parties who attended the following day. Children who sat on the same level of the auditorium as the index case were much more likely to be ill than those seated elsewhere (relative risk 7.1, 95% confidence interval 5.4-9.2. P < 0.001). The majority of other reported cases had not been present on the evening of the vomiting incident. Disinfection procedure was poor and the disinfectant used contained no sodium hypochlorite. Transmission most likely occurred through direct contact with contaminated fomites. The outbreak has implications for disinfection procedures following vomiting incidents at public venues.

Comparison of the compact dry TC and 3M petrifilm ACP dry sheet media methods with the spiral plate method for the examination of randomly selected foods for obtaining aerobic colony counts.

Two hundred thirty-six randomly selected food and milk samples were examined to obtain aerobic colony counts by two dry sheet media methods and a standard Public Health Laboratory Service spiral plate method. Results for 40 samples were outside the limits of detection for one or more of the tested methods and were not considered. (The limits of detection for the spiral plate method were 200 to 1 x 10(8) CFU/ml for the spiral plate method and 100 to 3 x 10(6) CFU/ml for the dry sheet media methods.) The remaining 196 sets of results were analyzed further. When the results from the three methods were compared, correlation coefficients were all >0.80 and slopes and intercepts were close to 1.0 and 0.0, respectively. Mean log values and standard deviations were very similar for all three methods. The results were evaluated according to published UK guidelines for ready-to-eat foods sampled at the point of sale, which include a quality acceptability assessment that is based on aerobic colony counts. Eighty-six percent of the comparable results gave the same verdict with regard to acceptability according to the aerobic colony count guidelines. Both dry sheet media methods were comparable to the spiral plate method and can be recommended for the examination of food.