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Monday, 4 August 2014

PREVENTING FOOD POISONING AT HOME


What is food poisoning?
Food poisoning is illness resulting from consumption of contaminated food or water. Food can be contaminated by bacteria, viruses, parasites or fungi, or by toxins produced by them. Food poisoning is one of the most common illnesses in Australia, with an estimated 4 to 7 million cases of foodborne illness each year.

General principles
Many different organisms can cause food poisoning. Most are particular types of bacteria and more than 95% of reported cases of bacterial food poisoning are caused by infection with just two species, Campylobacter and Salmonella. Dangerous bacteria can survive on many foods.

Sources
Sources of food poisoning include:
unpasteurised milk (raw or non-heat treated milk)
improperly handled eggs for example:

using cracked or dirty eggs
not washing hands after cracking or handling eggs
not refrigerating raw egg products
undercooked meats, including beef, pork and especially chicken
stored cooked rice, gravies and sauces (including home-made mayonnaise)
fresh fruit and vegetables.
Contaminated food may not look, smell or taste any different from food that is safe.
The risk of food poisoning is significantly reduced if food is correctly handled and cooked, eaten immediately or stored properly.

Causes
Food poisoning can be caused by:
preparing food without washing hands properly beforehand
someone who is sick preparing food for others to eat
eating food that is not cooked thoroughly
allowing food to be at a temperature, for more than 4 hours, that allows bacteria to grow well.

Keep food cold enough (fridge or freezer) or hot enough (steaming hot) to guard against bacterial growth. However, the bacteria Listeria can grow in refrigerators.

Listeria can cause illness and death in the elderly, people who are immune suppressed and in pregnant women. Infection can also cause miscarriage.
cross contamination from raw meat (red meat or white meat) in the kitchen. Raw meat is the most important source of dangerous bacteria. This is especially so with raw poultry which is nearly always contaminated with Campylobacter andSalmonella. Proper cooking kills these bacteria but they can be easily transferred to foods that won’t be further cooked (for example salads) by hands or utensils such as chopping boards or knives.

Avoid hand contact with raw meat but if this is not practical, wash hands (with soap and running water) thoroughly afterwards.

Thorough cleaning of chopping boards and knives with detergent and warm water is required after each use. Best practice is to have a separate chopping board for raw meat and to clean the board and utensils in a dishwasher.
drinking contaminated water.

Personal hygiene practices
Always wash your hands with soap and running water before preparing or eating food. Remember also to wash your hands after:
using the toilet for any reason. A variety of surfaces in the toilet may have traces of faeces on them
changing nappies
handling raw meat or eggs
using a handkerchief or tissue, coughing or sneezing
smoking
touching animals
handling garbage
gardening.

Do not
sneeze or cough over food
prepare food for others if suffering from throat, skin or bowel infections
smoke in areas where food is prepared
use a dirty tea towel for drying dishes – it is better to let them air dry on a draining board or dish rack.

Do
protect cuts and sores on the hands or fingers with a clean dressing and waterproof cover or disposable gloves
prevent hair from falling into food – tie it away from the face
ensure that children wash their hands before eating or assisting with food preparation
clean inside your cupboards and fridge regularly – crumbs in cupboards can attract pests and dirty fridges can harbour bacteria.

Pests
Pests such as flies, cockroaches and mice carry disease. Keep food safe by:
keeping flies out of the kitchen, storage and dining areas
using fly spray thoughtfully – cover all food before you spray and until you can no longer smell the spray
keeping food scraps stored in garbage bins with close fitting lids – this prevents pests eating the scraps and breeding
storing chemicals used to control pests in areas away from those used to store, prepare or eat food.

Pets
Do not allow animals into kitchens – in particular, do not feed them in the kitchen. Do not wash pet food bowls in the kitchen sink.

Shopping
The inside of a car provides the ideal environment and temperature for bacteria to multiply, so food should be in the car for as short a time as possible.
Get refrigerated and frozen foods at the end of the shopping trip and keep them cold.
Keep hot foods separate from cold foods.
Check date markings on food packages, for example, use by or best before dates.
Never buy or use
badly dented cans
leaking cartons, cans, bottles or containers
food packaged in torn or ripped packaging or packaging that has been tampered with
food packages or cans that are swollen
cracked or dirty eggs
ready-to-eat food that has been in contact with raw meat, chicken or their juices. Take note of how ready-to-eat foods are presented as you shop
products in vacuum packs if the packaging has become loose.
Storing food

Remember to:
store eggs in the fridge. This improves quality and minimises any safety risk
immediately freeze products that you do not intend to use before the use by date. Freezing greatly extends the use by date
check the temperature of your refrigerator using a fridge thermometer. It should be 5ºC or less.
Cooked food can be allowed to cool to reasonably warm (about 45ºC) before it is put into the fridge; it is not essential to let it completely cool. Food will cool faster in smaller containers, and metal containers lose heat faster than plastic ones.
Store raw meats near the bottom of the fridge to ensure that juices do not drip onto other foods. Alternatively, put meat onto a covered tray or container within the fridge.
Keep raw foods on separate plates from ready- to-eat foods such as cooked foods and salads. Bacteria still grow in foods that have been kept refrigerated – they just take longer to grow.

Handling and preparing food
Safe food handling and preparation practices include:
washing hands well with soap for at least 10 to 15 seconds and then rinsing with clean running water before preparing food, before eating and after touching raw meats
asking other people to prepare food if you are not feeling well
never placing cooked foods on dishes that have contained raw products such as meat, poultry and fish, unless the plates have been thoroughly washed first
never using a sauce on cooked food if it has been previously used to marinate raw meat or seafood, unless the marinade has been cooked first or will be cooked. For example, do not spoon the uncooked juices or marinade over the cooked food and serve. The uncooked marinade will probably contain harmful bacteria
all fruit and vegetables should be thoroughly washed if they are to be eaten raw. Sprouts and herbs should be rinsed before serving
never keep perishable food outside of a fridge for longer than 4 hours
never refrigerate perishable foods that have been at room temperature for more than 2 hours. This includes preparation and serving time.
Thawing frozen foods
Thaw meat and other foods in the bottom of the fridge whenever possible. Food can be thawed in a microwave oven, at room temperature (for example, on a bench) or in water, provided the food is cooked immediately after it has thawed.
Take great care if you cook meat when it is only partially thawed. Make sure that it is cooked right through.

Cooking and reheating
The surface of meat is usually the part that is contaminated with bacteria. Problems arise especially when contamination from the outside is moved to the inside, such as when meat is minced or sliced or a skewer is pushed through the meat. Then the meat must be thoroughly cooked right through. Therefore mince, sausages, hamburger patties, rolled roasts, kebabs, yiros, shasliks and other such foods should be cooked right through. Thorough cooking means that there is no pink meat and the juices run clear when the meat is skewered, cut or pressed.
If you have access to a meat thermometer, you can use it to check the internal temperatures. In the case of hamburgers and poultry, make sure they are cooked throughout. Aim for around 75ºC in the centre of the meat item.

Microwaves are a quick and convenient way to cook foods, but they tend to heat foods unevenly, leaving cold spots. So, when microwaving foods, always rotate and stir the food during cooking for more even cooking. Also, wait until the required standing time is over before you check that cooking is complete, because foods continue to cook even when the microwave is turned off.
When reheating foods, heat to steaming hot. This will kill any bacteria which may have grown on the food in the fridge.

Eating outdoors
(picnics, barbecues, camping, school lunches)
Warm summer weather is perfect for bacteria to grow.
Keep all food cold, unless it has just been cooked and will be eaten hot straight away. Do not pack food if it has just been cooked and will be eaten cool. Let it get cold in the fridge first.
Do the maximum amount of food preparation at home, particularly if hand washing facilities are inadequate at the place where the food will be eaten.

When camping, it is best to pack dried, canned and ultra heat treated (UHT) foods rather than fresh foods.

When packing children’s lunches, either pack a frozen ice block drink in the lunch box to keep food cold (summer and winter) or choose foods that will not ‘go off’. That is, do not pack foods that would normally be kept in the fridge, such as milk, soft cheese, meats or eggs, even in sandwiches.

Fillings for sandwiches that are fairly safe under warmer conditions are often those fillings that can sit on a shelf without needing refrigeration, such as honey, yeast extracts and peanut butter products.

In some schools where there are children with severe allergies to nuts and nut products, parents may be asked not to include nuts and nut products in their children’s school lunches.

Eating out (restaurants and take-aways)
Cold foods should be cold to the touch and should be displayed on ice or in a fridge.
Poultry, mince, sausages, hamburger patties, rolled roasts, kebabs, yiros, shasliks and other such foods should be cooked right through. If they are not, send them back.
Eat hot foods while they are still hot. Be careful about handling leftovers, including foods taken home in a ‘doggy bag’. They should be put in the refrigerator as soon as possible.

FOOD POISONING - SYMPTOMS, TREATMENT AND PREVENTION


Food poisoning is an illness caused by eating contaminated food. The most common sources of contamination are bacteria or toxic substances produced by bacteria. Some viruses and fungi can also cause food poisoning.
Food poisoning is a notifiable disease.

How food poisoning occurs
Bacteria may contaminate food as a result of farming or other production methods or poor preparation, handling or storage of food. Contaminated food may not look, smell or taste any different from food that is safe.

SIGNS AND SYMPTOMS
Typical symptoms are a sudden onset of:
nausea
vomiting

stomach cramps

diarrhoea. 

The illness usually lasts from less than 24 hours to several days depending on the cause. Occasional severe cases last longer and may require hospitalisation.
While single cases of food poisoning undoubtedly occur, they are difficult to detect and frequently go unreported. Food poisoning is usually recognised as a typical illness occurring in a group of people shortly after eating a common food.

Diagnosis
Detection of large numbers of certain bacteria in suspect food samples and detection of the same bacteria in samples of faeces from affected people confirm the diagnosis of food poisoning.
Incubation period
(time between becoming infected and developing symptoms)
Varies depending on the cause, but usually from a few hours to a few days. Although many ill people blame a food they ate before they got ill, experience indicates that this food is usually not the cause of the illness.
Infectious period
(time during which an infected person can infect others)
Depends on what has caused the illness. Not all causes of food poisoning are able to be spread from person-to-person, but some are.

TREATMENT
Treatment varies depending on what is the cause of the food poisoning. Usually these illnesses do not require antibiotic treatment.

PREVENTION
If the cause is not known, it should be assumed that it may be possible to spread from person-to-person, or for an infected person to contaminate food and indirectly infect others. Therefore:
Exclude from childcare, preschool, school or work until there has been no diarrhoea or vomiting for 24 hours. If working as a food handler in a food business, the exclusion period should be until there has been no diarrhoea or vomiting for 48 hours
follow good hand washing and keeping areas clean procedures
good food handling procedures should always be followed
do not allow people affected by food poisoning to prepare food for others until there has been no diarrhea or vomiting for 24 hours
people who have diarrhoea should not use public swimming pools until there has been no diarrhoea for at least 24 hours
babies and small children who are not toilet trained should wear tight fitting waterproof pants or swimming nappies in swimming pools and changed regularly in the change room. When faecal accidents occur, swimming pools should be properly disinfected.

MALARIA - SYMPTOMS, TREATMENT AND PREVENTION


Malaria is caused by a parasite called Plasmodium. There are 5 species of Plasmodiumwhich infect humans:
Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium knowlesi which is less common.

Of these, Plasmodium falciparum infection is the most severe and can cause death in up to 10% of cases. It can be rapidly fatal. Pregnant women and children are especially at risk. Other types of malaria are less severe, but still may cause death.

Malaria is a notifiable disease.

How malaria is spread
The parasite is transmitted to humans by the bite of infected female Anopheles species mosquitoes.

The parasites multiply in the liver and the bloodstream of the infected person. The parasite may be taken up by another mosquito when it bites an infected person. The mosquito is then infected for the duration of its life and can infect other humans when it bites them.

Occasionally malaria is transmitted by blood transfusion. For this reason, people who have travelled to countries where malaria occurs may be deferred from giving blood for a short period. Malaria can also be transmitted from a mother to her fetus.

Malaria occurs in most tropical and sub-tropical areas of the world, including:
Africa
Central and South America
Asia (including southeast Asia)
Papua New Guinea
western Pacific islands.

Over a million people living in these countries die from malaria each year. Many thousands of tourists also get malaria during their travels to countries where malaria is present. Tourists often get severe illness because they have had no previous exposure to malaria and have no resistance to the disease.

SIGNS AND SYMPTOMS
In humans, the parasites live mostly in the red blood cells, but a very serious complication of Plasmodium falciparum malaria is infection of the brain.
Symptoms of malaria may include:
fever, which may come and go, or may be constant
chills
profuse sweating
malaise (feeling of unwellness)
muscle and joint pain
headache
confusion
nausea
loss of appetite
diarrhoea
abdominal pain
cough.

Diagnosis
Diagnosis is made by a blood test – sometimes it is necessary to repeat the test a number of times, as the parasites can be difficult to detect.

Incubation period
(time between becoming infected and developing symptoms)

Varies with the type:
P. falciparum: 9 to 14 days
P . vivax: 12 to18 days but some strains may have an incubation period of 8 to 10 months or longer
P. ovale: 12 to 18 days
P. malariae: 18 to 40 days.
These periods are approximate and may be longer if the person has been taking drugs taken to prevent infection.
Infectious period
(time during which an infected person can infect others)
Direct person-to-person spread does not occur.
A person remains infectious as long as the parasites are present in the blood. This may be several years if adequate treatment is not given. Parasites disappear from the blood within a few days of commencing appropriate treatment. Mosquitoes remain infected for life.

TREATMENT
Specific antimalarial treatment is available and must always be started as soon as malaria is diagnosed. There is increasing resistance to currently available drugs and treatment should be carried out by an infectious diseases specialist or other expert in the field.

PREVENTION
Exclusion from childcare, preschool, school or work is not necessary but cases should avoid being bitten by mosquitoes while they are unwell
there is no vaccine to prevent human infection by this parasite
personal protection and the environmental management of mosquitoes are important in preventing illness. See Fight the Bite for tips to on how to protect yourself.

Travel in countries where there is malaria?
Extensive international programs are undertaken in malarious countries to try to control this disease. For travellers, the following advice is given:
see a travel medicine expert before you go to get specific advice for the places you will be visiting
always take malaria prophylaxis drugs exactly as prescribed and take the full course. Be aware of their potential side effects
protect yourself from mosquito bites. Travel medical centres have good information on how to do this
be aware that no preventive measures are 100% effective, so always seek medical attention immediately if you develop a fever while travelling in, or after return from, a country where malaria occurs
always give your doctor the information about your travel if you become sick.


BREAST CANCER, CAUSES, SYMPTOMS & TREATMENT PART 2

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:

·         Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
·         Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
·         Mammogram : An x-ray of the breast.


Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called asonogram. The picture can be printed to be looked at later.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

Biopsy : The removal of cells or tissues so they can be viewed under a microscope by apathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to remove a small piece of the lump. Four types of biopsies are as follows:

 Excisional biopsy : The removal of an entire lump of tissue.

  Incisional biopsy : The removal of part of a lump or a sample of tissue

  Core biopsy : The removal of tissue using a wide needle.

Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid, using a thin needle.

If cancer is found, tests are done to study the cancer cells.
  • Decisions about the best treatment are based on the results of these tests. The tests give information about:
    ·         how quickly the cancer may grow.
    ·         how likely it is that the cancer will spread through the body.
    ·         how well certain treatments might work.
    ·         how likely the cancer is to recur (come back).
    Tests include the following:
    · Estrogen and progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormonesreceptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
    ·         Human epidermal growth factor type 2 receptor (HER2/neu) test: A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab andlapatinib.
    ·         Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).
    o    Oncotype DX: This test helps predict whether stage I or stage II breast cancer that isestrogen receptor positive and node-negative will spread to other parts of the body. If the risk of the cancer spreading is high, chemotherapy may be given to lower the risk.
    o    MammaPrint: This test helps predict whether stage I or stage II breast cancer that is node-negative will spread to other parts of the body. If the risk of the cancer spreading is high, chemotherapy may be given to lower the risk.
    There are three ways that cancer spreads in the body.
    Cancer can spread through tissue, the lymph system, and the blood:
    ·         Tissue. The cancer spreads from where it began by growing into nearby areas.
    ·         Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
    ·         Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
    Cancer may spread from where it began to other parts of the body.
    When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
    ·         Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
    ·         Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

    The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
    ·         There are different types of treatment for patients with breast cancer.
    ·         Six types of standard treatment are used:
    o    Surgery
    o    Sentinel lymph node biopsy followed by surgery
    o    Radiation therapy
    o    Chemotherapy
    o    Hormone therapy
    o    Targeted therapy
    ·         New types of treatment are being tested in clinical trials.
    o    High-dose chemotherapy with stem cell transplant
    ·         Patients may want to think about taking part in a clinical trial.
    ·         Patients can enter clinical trials before, during, or after starting their cancer treatment.
    ·         Follow-up tests may be needed