Good Practices in Home Kitchens: Construction and Validation of an Instrument for Household Food-Borne Disease Assessment and Prevention

Updated-Food Choice Questionnaire: Cultural Adaptation and Validation in a Spanish-Speaking Population from Mexico

BACKGROUND

Determinants and motives related to food selection have evolved in a globalized and changing world. The traditional and useful Food Choice Questionnaire (FCQ), created in 1995, needs to be updated, adapted to new scenarios, and validated.

OBJECTIVES

This study aimed to: (1) assess face validity (FV) of the original 36-item FCQ, (2) generate an Updated-FCQ (U-FCQ) and assess its content validity (CV) (instrument suitability), and (3) evaluate its construct validity and reliability in a Spanish-speaking population from Mexico.

METHODS

FV involved a panel of nutrition professionals (NPs) rating the original items' clarity, relevance, specificity, and representativeness. A literature review process updated the FCQ by adding new items. CV with a second NP panel allowed calculating content validity ratio (CVR). Construct validation was performed via exploratory and confirmatory factor analysis (EFA-CFA). Internal consistency through Cronbach's alpha (CA) and test-retest reliability via intra-class correlation (ICC) were assessed.

RESULTS

The FV (n = 8) resulted in the modification of 11 original items. The literature review added 36 new items (15 from previous adaptations and 21 original items). The CV (n = 13) identified nine items (non-acceptable CVR), prompting reformulation of seven and removal of two. The NPs' feedback added six new items. The EFA-CFA (n = 788) developed a 75-item U-FCQ with eight dimensions: sensory appeal, mood, health and nutritional content, price, food identity, environmental and wildlife awareness, convenience, and image management. CA ranged from 0.74-0.97 (good-excellent) and ICC from 0.51-0.78 (moderate-good).

CONCLUSIONS

This study provides a useful instrument for the assessment of food choices and lays the groundwork for future cross-cultural comparisons, expanding its applicability in wider settings.

Microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home: a systematic review

CONTEXT

The safety of enteral formulas is important to restore and maintain the health of patients.

OBJECTIVE

A systematic review of the literature was conducted to assess the microbiological contamination present in enteral tube feeding prepared in hospitals and/or at home.

DATA SOURCES

A systematic search was conducted of the Medline, Scopus, BVS, CAPES/MEC, Embase, Science Direct, and SciELO databases and gray literature.

DATA EXTRACTION

Eligible studies that analyzed the contamination of enteral formulas manipulated in hospitals and/or at home were selected; a quality assessment tool was used.

DATA ANALYSIS

Twenty-three studies evaluated 1099 enteral formulations. Of these, 44.67% of enteral formulas (n = 491) exceeded the acceptable bacterial count. Samples of homemade enteral formulation preparations (86.03%; n = 191) had the highest bacterial counts, followed by mixed preparations (79.72%; n = 59), and commercial formulas (30.01%; n = 241). The number of samples of enteral formulations that exceeded the bacterial count at home was 70.79% (n = 160 at the hospital was 37.91% (n = 331). Total coliforms (82.68%; n = 406) and mesophilic aerobes (79.22%; n = 389) were the most common microorganisms. Samples with bacterial pathogens were also identified, with Bacillus cereus (4.07%; n = 20) and Listeria monocytogenes (3.66%; n = 18) being the most prevalent.

CONCLUSIONS

A high number of samples of enteral formulations exceeded the bacterial count, but the risk to patient's health when consuming enteral tube feeding prepared in hospitals or at home may be low. This is because the bacteria present in the samples are not considered potential causes of disease but rather indicators of hygiene conditions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022367573.

Checklist to assess food safety when handling home enteral nutrition

BACKGROUND

Identifying food safety risks when handling enteral formulations at home is important to restore and maintain the health of patients. Therefore, this study developed and validated a food safety assessment checklist for handling home enteral nutrition (HEN).

METHODS

This methodological study developed a checklist based on a literature review and interviews with food safety professionals. The content validation, which was conducted by food safety and enteral feeding experts, assessed the relevance, clarity, and simplicity of the checklist using the content validity index of items (CVI-I), categories (CVI-C), and the entire instrument (CVI-EI). Each item was rated as either essential, necessary, or recommended according to the risk in relation to foodborne diseases.

RESULTS

The Food Safety for Handling Home Enteral Nutrition checklist (FSHEN checklist) that was developed includes 40 items and the following eight categories: physical structure; cleaning of facilities, equipment, furniture, and utensils; pests and waste; water supply; food handlers; ingredients and packaging; handling of enteral formulations; and the bottling and storage of enteral formulations. The CVI-EI was above the recommendation (≥0.93) for the three assessed criteria, as was the CVI-C in terms of clarity (≥0.95), relevance (≥0.98), and simplicity (≥0.84). A total of 52.5% of the items were rated as essential, 32.5% as necessary, and 15% as recommended.

CONCLUSION

The FSHEN checklist is relevant, clear, and easy to use. It can help health professionals and individuals working in the field to assess and prioritize items to improve food safety in the management of HEN.

Microbial Contamination and Public Health: An Overview

Food contamination with microbial agents can take place at any stage of the food chain, from farm to fork. For this reason, good hygienic and manufacturing practices must be followed along the entire food chain to prevent microbiological food contamination due to microbes which can cause high incidence of morbidity and mortality among consumers. Recent research have been focused on the implementation of innovative technologies for enhancing the quality and safety of food without compromising its organoleptic and nutritional characteristics. Studies should be addressed to the development of simple, less expensive, and fast tests for monitoring and controlling microbial food contamination, as well as to the development of new food manufacturing processes.

Food Safety Conditions in Home-Kitchens: A Cross-Sectional Study in the Federal District/Brazil

This study aimed to analyze the food safety conditions in home kitchens from the Brazilian Federal District. A previously validated instrument composed of 77 items (in four blocks) was used to evaluate the safety conditions in home kitchens. A survey was carried out with on-site application with 226 home kitchens’ food handlers in the Federal District, Brazil to evaluate Brazilian home kitchens’ good practices. Of the home kitchen food handlers, most of them were female (64.6%), had completed undergraduate education (29.2%), and were 45–59 years old (23.5%). The visited households had an average of 3.38 ± 1.48 residents that ate some of their meals at home, and 40% declared the monthly family income to be between 5 and 15 Brazilian minimum wages (MW). Regarding the reliability of the instrument, from the KR-20 test, it was verified that the instrument presents good internal consistency (α = 0.758). According to the instrument classification, the home kitchens’ sample was considered as at a medium risk of food contamination (46.5% of them presented from 51 to 75% of conformities to the instrument). There was a statistical difference between house-kitchens with a family income from zero to one minimum wage (MW) and those receiving from 5 to 15 MW (p = 0.017), as well as between those from zero to one MW and who earn above 15 MW (p = 0.009). The result of the on-site evaluation shows that the instrument was able to measure food safety conditions in Brazilian Federal District domestic kitchens. Such findings can contribute positively to the development of actions in health education that help in the adoption of good practices of food manipulation and, consequently, in the reduction in foodborne disease outbreaks in residences.

Brazilian Vegetarian Population-Influence of Type of Diet, Motivation and Sociodemographic Variables on Quality of Life Measured by Specific Tool (VEGQOL)

The adoption of a vegetarian diet has been associated with positive health outcomes. However, few studies evaluate the effect of this eating pattern on quality of life. Moreover, no specific instrument for the vegetarian population to measure the quality of life is available worldwide. Therefore, this study aimed to elaborate and validate a specific questionnaire to measure the quality of life in vegetarians. The Specific Vegetarian Quality of Life Questionnaire (VEGQOL) was constructed based on other instruments and studies related to vegetarianism. The content and semantic validation were performed by a group of experts, followed by a pilot study to evaluate the questionnaire acceptability and reproducibility. Discriminant validation was tested using the WHOQOL as the gold standard measure (Pearson correlation ranging from 0.302 of the domain 3 to 0.392 of the domain 2). Afterward, a nationwide survey was conducted using VEGQOL. Content and semantic validation selected 19 of the initial 30 items. VEGQOL presented good reproducibility (Cohen's Kappa coefficient ranging from 0.361 to 0.730 and intraclass correlation coefficient of 0.820) and internal consistency (0.708), both adequate to evaluate the quality of life in vegetarians. The sample size (n = 5014 individuals, error of 3% at a level of significance of 5%) and distribution was representative of the Brazilian vegetarian population. In general, the quality of life of Brazilian vegetarians was considered satisfactory (VEGQOL cut off points 70-80). Among different types of vegetarians, the vegans showed better results with a VEGQOL mean value of 79.2 ± 10.7. Older individuals, the ones who adopted the diet for a longer time (VEGQOL mean value of 75.8 ± 12.7) and the ones who had other vegetarians in their social network (VEGQOL mean value of 74.6 ± 12.2) also had a better quality of life score. Individuals who adopted it for ethical or health reasons had a higher quality of life score. The questionnaire produced in this study is a useful tool for future research in this area. Results were better for vegans and for the ones who adopt the diet for ethical or health reasons.

Content Validation through Expert Judgement of an Instrument on the Nutritional Knowledge, Beliefs, and Habits of Pregnant Women

The aim of this study was to conduct content validation through expert judgement of an instrument which explores the nutritional knowledge, beliefs, and habits during pregnancy. This is a psychometric study in which 14 experts participated in the evaluation of each of the questionnaire items, which were divided into two blocks according to the characteristics of sufficiency, clarity, coherence, and relevance. Fleiss’ κ statistic was used to measure strength of agreement. A pre-test with 102 participants was conducted to measure the degree of understandability of the instrument. The strength of agreement obtained for each of the dimensions was almost perfect. For each pair of experts, strength of agreement ranged between substantial and almost perfect. Sufficiency was the characteristic of the questionnaire that obtained the highest values in the two blocks, and was also the most statistically significant (p < 0.001). Coherence was the most statistically significant characteristic in the first block (p = 0.030). Clarity was the most statistically significant characteristic in the second block (p = 0.037). The wording of five of the twenty original items was corrected. The new version of the instrument attained a high degree of understandability. The results suggest that the instrument is valid and may therefore be applied.

Agent-Based Modeling of a Self-Organized Food Safety System

“The wisdom of crowds” is often observed in social discourses and activities around us. The manifestations of it are, however, so intrinsically embedded and behaviorally accepted that an elaboration of a social phenomenon evidencing such wisdom is often considered a discovery; or at least an astonishing fact. One such scenario is explored here, namely, the conceptualization and modeling of a food safety system—a system directly related to social cognition. The first contribution of this paper is the re-evaluation of Knowles’s model towards a more conscious understanding of “the wisdom of crowds” effects on inspection and consumption behaviors. The second contribution is augmenting the model with social networking capabilities, which acts as a medium to spread information about stores and help consumers find uncontaminated stores. Simulation results revealed that stores respecting social cognition improve the effectiveness of the food safety system for consumers as well as for the stores. Simulation findings also revealed that active societies have the capability to self-organize effectively, even if they lack regulatory obligations.