Evaluation of the safety of domestic food preparation in Malaysia.
Food-handling practices were studied in 119 and 158 households, respectively, in an urban and a rural community in Peninsular Malaysia. Hazard analyses, including microbiological analysis of foods, were carried out in two households in each community and in a house that prepared food for distribution in the urban area. Kitchen hygiene was generally acceptable, although rated "poor" in some instances in the rural area. Food prepared for lunch was usually sufficient for dinner also, the leftover items being stored at ambient temperature until required. In the house that prepared food for distribution, breakfast was prepared during the evening, stored at ambient temperature overnight, and reheated before sale the next morning. There was a local preference for cooking food at temperatures close to boiling point; this reduced the numbers of vegetative cells but not those of spores. In some stored foods the populations of Staphylococcus aureus, Bacillus cereus and mesophilic aerobic bacteria increased, the last-mentioned reaching spoilage levels. Reheating reduced the populations of proliferating bacteria in most foods to acceptable levels but would not have destroyed heat-resistant enterotoxins. Because of their importance in combating acute bacterial foodborne disease, the control of the temperature and time factors during the cooking and storage of food should receive special attention in education on health and food safety.
Street foods in Accra, Ghana: how safe are they?
OBJECTIVE
To investigate the microbial quality of foods sold on streets of Accra and factors predisposing to their contamination.


METHODS
Structured questionnaires were used to collect data from 117 street vendors on their vital statistics, personal hygiene, food hygiene and knowledge of foodborne illness. Standard methods were used for the enumeration, isolation, and identification of bacteria.


FINDINGS
Most vendors were educated and exhibited good hygiene behaviour. Diarrhoea was defined as the passage of > or =3 stools per day) by 110 vendors (94.0%), but none associated diarrhoea with bloody stools; only 21 (17.9%) associated diarrhoea with germs. The surroundings of the vending sites were clean, but four sites (3.4%) were classified as very dirty. The cooking of food well in advance of consumption, exposure of food to flies, and working with food at ground level and by hand were likely risk factors for contamination. Examinations were made of 511 menu items, classified as breakfast/snack foods, main dishes, soups and sauces, and cold dishes. Mesophilic bacteria were detected in 356 foods (69.7%): 28 contained Bacillus cereus (5.5%), 163 contained Staphylococcus aureus (31.9%) and 172 contained Enterobacteriaceae (33.7%). The microbial quality of most of the foods was within the acceptable limits but samples of salads, macaroni, fufu, omo tuo and red pepper had unacceptable levels of contamination. Shigella sonnei and enteroaggregative Escherichia coli were isolated from macaroni, rice, and tomato stew, and Salmonella arizonae from light soup.


CONCLUSION
Street foods can be sources of enteropathogens. Vendors should therefore receive education in food hygiene. Special attention should be given to the causes of diarrhoea, the transmission of diarrhoeal pathogens, the handling of equipment and cooked food, hand-washing practices and environmental hygiene.
Professional tensions in client-centered practice: using institutional ethnography to generate understanding and transformation.
For almost 20 years, occupational therapists have advocated client-centered practice. Yet client-centered practice is fraught with tensions that arise outside the practice of individual occupational therapists. This paper is guided by two questions: What produces professional tensions in client-centered practice? and What understanding and change might be generated using institutional ethnography? The sociological theory and method of institutional ethnography are described using data from an ongoing investigation of mental health services as a social institution. Illustrated are the research aim, research questions, and institutional analysis that distinguish institutional ethnography from conventional ethnography. Two professional tensions are associated with attempts to fulfill client-centered practice in mental health. One is that of working at cross-purposes with the prevailing hierarchical structure; the other tension is that of being celebrated yet subordinated in the medical and management hierarchies of health services. Although client-centered practice is difficult to do, the authors recommend institutional ethnography as a research approach to generate understanding and transformation of the context and practice of occupational therapy.