Feasibility of using health data sources to inform product safety surveillance in Queensland : a report for the Queensland Injury Prevention Council

This report provides an evaluation of the current available evidence-base for identification and surveillance of product-related injuries in children in Queensland. While the focal population was children in Queensland, the identification of information needs and data sources for product safety surveillance has applicability nationally for all age groups. The report firstly summarises the data needs of product safety regulators regarding product-related injury in children, describing the current sources of information informing product safety policy and practice, and documenting the priority product surveillance areas affecting children which have been a focus over recent years in Queensland. Health data sources in Queensland which have the potential to inform product safety surveillance initiatives were evaluated in terms of their ability to address the information needs of product safety regulators. Patterns in product-related injuries in children were analysed using routinely available health data to identify areas for future intervention, and the patterns in product-related injuries in children identified in health data were compared to those identified by product safety regulators. Recommendations were made for information system improvements and improved access to and utilisation of health data for more proactive approaches to product safety surveillance in the future.

Safety and quality and stage of distribution

Let 0 denote the level of quality inherent in a food product that is delivered to some terminal market. In this paper, I characterize allocations over 0 and provide an economic rationale for regulating safety and quality standards in the food system. Zusman and Bockstael investigate the theoretical foundations for imposing standards and stress the importance of providing a tractable conceptual foundation. Despite a wealth of contributions that are mainly empirical (for reviews of these works see, respectively, Caswell and Antle), there have been relatively few attempts to model formally the linkages between farm and food markets when food quality and consumer safety are at issue. Here, I attempt to provide such a framework, building on key contributions in the theoretical literature and linking them in a simple model of quality determination in a vertically related marketing channel. The food-marketing model is due to Gardner. Spence provides a foundation for Pareto-improving intervention in a deterministic model of quality provision, and Leland, building on the classic paper by Akerlof, investigates licensing and minimum standards when the information structure is incomplete. Linking these ideas in a satisfactory model of the food markets is the main objective of the paper.

Hospital outpatient responses to potential driving impairment due to prescribed medications

Driving and using prescription medicines that have the potential to impair driving is an emerging research area. To date it is characterised by a limited (although growing) number of studies and methodological complexities that make generalisations about impairment due to medications difficult. Consistent evidence has been found for the impairing effects of hypnotics, sedative antidepressants and antihistamines, and narcotic analgesics, although it has been estimated that as many as nine medication classes have the potential to impair driving (Alvarez & del Rio, 2000; Walsh, de Gier, Christopherson, & Verstraete, 2004). There is also evidence for increased negative effects related to concomitant use of other medications and alcohol (Movig et al., 2004; Pringle, Ahern, Heller, Gold, & Brown, 2005). Statistics on the high levels of Australian prescription medication use suggest that consumer awareness of driving impairment due to medicines should be examined. One web-based study has found a low level of awareness, knowledge and risk perceptions among Australian drivers about the impairing effects of various medications on driving (Mallick, Johnston, Goren, & Kennedy, 2007). The lack of awareness and knowledge brings into question the effectiveness of the existing countermeasures. In Australia these consist of the use of ancillary warning labels administered under mandatory regulation and professional guidelines, advice to patients, and the use of Consumer Medicines Information (CMI) with medications that are known to cause impairment. The responsibility for the use of the warnings and related counsel to patients primarily lies with the pharmacist when dispensing relevant medication. A review by the Therapeutic Goods Administration (TGA) noted that in practice, advice to patients may not occur and that CMI is not always available (TGA, 2002). Researchers have also found that patients' recall of verbal counsel is very low (Houts, Bachrach, Witmer, Tringali, Bucher, & Localio, 1998). With healthcare observed as increasingly being provided in outpatient conditions (Davis et al., 2006; Vingilis & MacDonald, 2000), establishing the effectiveness of the warning labels as a countermeasure is especially important. There have been recent international developments in medication categorisation systems and associated medication warning labels. In 2005, France implemented a four-tier medication categorisation and warning system to improve patients' and health professionals' awareness and knowledge of related road safety issues (AFSSAPS, 2005). This warning system uses a pictogram and indicates the level of potential impairment in relation to driving performance through the use of colour and advice on the recommended behaviour to adopt towards driving. The comparable Australian system does not indicate the severity level of potential effects, and does not provide specific guidelines on the attitude or actions that the individual should adopt towards driving. It is reliant upon the patient to be vigilant in self-monitoring effects, to understand the potential ways in which they may be affected and how serious these effects may be, and to adopt the appropriate protective actions. This thesis investigates the responses of a sample of Australian hospital outpatients who receive appropriate labelling and counselling advice about potential driving impairment due to prescribed medicines. It aims to provide baseline data on the understanding and use of relevant medications by a Queensland public hospital outpatient sample recruited through the hospital pharmacy. It includes an exploration and comparison of the effect of the Australian and French medication warning systems on medication user knowledge, attitudes, beliefs and behaviour, and explores whether there are areas in which the Australian system may be improved by including any beneficial elements of the French system. A total of 358 outpatients were surveyed, and a follow-up telephone survey was conducted with a subgroup of consenting participants who were taking at least one medication that required an ancillary warning label about driving impairment. A complementary study of 75 French hospital outpatients was also conducted to further investigate the performance of the warnings. Not surprisingly, medication use among the Australian outpatient sample was high. The ancillary warning labels required to appear on medications that can impair driving were prevalent. A subgroup of participants was identified as being potentially at-risk of driving impaired, based on their reported recent use of medications requiring an ancillary warning label and level of driving activity. The sample reported previous behaviour and held future intentions that were consistent with warning label advice and health protective action. Participants did not express a particular need for being advised by a health professional regarding fitness to drive in relation to their medication. However, it was also apparent from the analysis that the participants would be significantly more likely to follow advice from a doctor than a pharmacist. High levels of knowledge in terms of general principles about effects of alcohol, illicit drugs and combinations of substances, and related health and crash risks were revealed. This may reflect a sample specific effect. Emphasis is placed in the professional guidelines for hospital pharmacists that make it essential that advisory labels are applied to medicines where applicable and that warning advice is given to all patients on medication which may affect driving (SHPA, 2006, p. 221). The research program applied selected theoretical constructs from Schwarzer's (1992) Health Action Process Approach, which has extended constructs from existing health theories such as the Theory of Planned Behavior (Ajzen, 1991) to better account for the intention-behaviour gap often observed when predicting behaviour. This was undertaken to explore the utility of the constructs in understanding and predicting compliance intentions and behaviour with the mandatory medication warning about driving impairment. This investigation revealed that the theoretical constructs related to intention and planning to avoid driving if an effect from the medication was noticed were useful. Not all the theoretical model constructs that had been demonstrated to be significant predictors in previous research on different health behaviours were significant in the present analyses. Positive outcome expectancies from avoiding driving were found to be important influences on forming the intention to avoid driving if an effect due to medication was noticed. In turn, intention was found to be a significant predictor of planning. Other selected theoretical constructs failed to predict compliance with the Australian warning label advice. It is possible that the limited predictive power of a number of constructs including risk perceptions is due to the small sample size obtained at follow up on which the evaluation is based. Alternately, it is possible that the theoretical constructs failed to sufficiently account for issues of particular relevance to the driving situation. The responses of the Australian hospital outpatient sample towards the Australian and French medication warning labels, which differed according to visual characteristics and warning message, were examined. In addition, a complementary study with a sample of French hospital outpatients was undertaken in order to allow general comparisons concerning the performance of the warnings. While a large amount of research exists concerning warning effectiveness, there is little research that has specifically investigated medication warnings relating to driving impairment. General established principles concerning factors that have been demonstrated to enhance warning noticeability and behavioural compliance have been extrapolated and investigated in the present study. The extent to which there is a need for education and improved health messages on this issue was a core issue of investigation in this thesis. Among the Australian sample, the size of the warning label and text, and red colour were the most visually important characteristics. The pictogram used in the French labels was also rated highly, and was salient for a large proportion of the sample. According to the study of French hospital outpatients, the pictogram was perceived to be the most important visual characteristic. Overall, the findings suggest that the Australian approach of using a combination of visual characteristics was important for the majority of the sample but that the use of a pictogram could enhance effects. A high rate of warning recall was found overall and a further important finding was that higher warning label recall was associated with increased number of medication classes taken. These results suggest that increased vigilance and care are associated with the number of medications taken and the associated repetition of the warning message. Significantly higher levels of risk perception were found for the French Level 3 (highest severity) label compared with the comparable mandatory Australian ancillary Label 1 warning. Participants' intentions related to the warning labels indicated that they would be more cautious while taking potentially impairing medication displaying the French Level 3 label compared with the Australian Label 1. These are potentially important findings for the Australian context regarding the current driving impairment warnings about displayed on medication. The findings raise other important implications for the Australian labelling context. An underlying factor may be the differences in the wording of the warning messages that appear on the Australian and French labels. The French label explicitly states "do not drive" while the Australian label states "if affected, do not drive", and the difference in responses may reflect that less severity is perceived where the situation involves the consumer's self-assessment of their impairment. The differences in the assignment of responsibility by the Australian (the consumer assesses and decides) and French (the doctor assesses and decides) approaches for the decision to drive while taking medication raises the core question of who is most able to assess driving impairment due to medication: the consumer, or the health professional? There are pros and cons related to knowledge, expertise and practicalities with either option. However, if the safety of the consumer is the primary aim, then the trend towards stronger risk perceptions and more consistent and cautious behavioural intentions in relation to the French label suggests that this approach may be more beneficial for consumer safety. The observations from the follow-up survey, although based on a small sample size and descriptive in nature, revealed that just over half of the sample recalled seeing a warning label about driving impairment on at least one of their medications. The majority of these respondents reported compliance with the warning advice. However, the results indicated variation in responses concerning alcohol intake and modifying the dose of medication or driving habits so that they could continue to drive, which suggests that the warning advice may not be having the desired impact. The findings of this research have implications for current countermeasures in this area. These have included enhancing the role that prescribing doctors have in providing warnings and advice to patients about the impact that their medication can have on driving, increasing consumer perceptions of the authority of pharmacists on this issue, and the reinforcement of the warning message. More broadly, it is suggested that there would be benefit in a wider dissemination of research-based information on increased crash risk and systematic monitoring and publicity about the representation of medications in crashes resulting in injuries and fatalities. Suggestions for future research concern the continued investigation of the effects of medications and interactions with existing medical conditions and other substances on driving skills, effects of variations in warning label design, individual behaviours and characteristics (particularly among those groups who are dependent upon prescription medication) and validation of consumer self-assessment of impairment.

Screening for biological activities with application in aquaculture in halophytes from the Algarve coastline

Infectious diseases often hamper the production of aquatic organisms in aquaculture systems, causing economical losses, environmental problems and consumer safety issues. The conventional way aquaculture producers had to control pathogens was by means of synthetic antibiotics and chemicals. This procedure had consequences in the emergence of more resilient pathogens, drug contamination of seafood products and local ecosystems. To avoid the repercussions of antibiotic use, vaccination has greatly replaced human drugs in western fish farms. However there is still massive unregulated antibiotic use in third world fish farms, so less expensive therapeutic alternatives for drugs are desperately needed. An alternative way to achieve disease control in aquaculture is by using natural bioactive organic compounds with antibiotic, antioxidant and/or immunostimulant properties. Such diverse biomolecules occur in bacteria, algae, fungi, higher plants and other organisms. Fatty acids, nucleotides, monosaccharides, polysaccharides, peptides, polyphenols and terpenoids, are examples of these substances. One promising source of bioactive compounds are salt tolerant plants. Halophytes have more molecular resources and defence mechanisms, when compared with other tracheophytes, to deal with the oxidative stresses of their habitat. Many halophytes have been used as a traditional food and medical supply, especially by African and Asian cultures. This scientific work evaluated the antibiotic, antioxidant, immunostimulant and metal chelating properties of Atriplex halimus L., Arthrocnemum macrostachyum Moric., Carpobrotus edulis L., Juncus acutus L. and Plantago coronopus L., from the Algarve coast. The antibiotic properties were tested against Listonella anguillarum, Photobacterium damselae piscicida and Vibrio fischeri. The immunostimulant properties were tested with cytochrome c and Griess assays on Sparus aurata head-kidney phagocytes. J. acutus ether extract inhibited the growth of P. damselae piscicida. A. macrostachyum, A. halimus, C. edulis, Juncus acutus and P. coronopus displayed antioxidant, copper chelating and iron chelating properties. These plants show potential as sources of bioactive compounds with application in aquaculture and in other fields.

Validação de um método de cromatografia de alta eficiência para determinação de conservantes em géneros alimentícios

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Química e Biológica

A segurança dos consumidores

The present report, about consumer’s safety, shows the development of the knowledge on this particular subject and the actions carried out by entities that fight for the protection of consumer’s rights. The internship was based on the knowledge acquirement on the theoretical and practical aspects of the fight lead by the Direção Geral do Consumidor, together with other entities, towards the elimination or solely the reduction of risks caused by some products and services made available for the consumers or put on the market. During the internship, I counted with the support of my supervisor in the DGC, Dr. Ana Catarina Fonseca and, for the writing of the report, I had the help of my thesis advisor, Dr. Jorge Morais Carvalho, whenever I needed constructive criticism. My participation on the creation of the informative brochures about consumer’s safety, and the study of the legislation used by the DGC on the daily work, enabled me, effectively, to consolidate my guiding principles as a future professional on the matters of the creation of entities, private and public, which aim to ensure the protection of consumers’s rights, informing them of the possible risks or solving the already existing problems, removing dangerous products and services from the market.The report clarifies the action of the DGC on the protection of consumer’s safety, and enables some knowledge on the relations between the entities that work for the protection of the consumers and the market operators and on their work on identifying dangerous products and warning the consumers about it. The final part of this report contains information that allows us to form an idea of the importance that consumer safety has had in Cape Verde, compared with the laws of Portugal on the matter.

PCR detection of staphylococcal enterotoxin genes in Staphylococcus aureus strains isolated from raw and pasteurized milk

Milk is considered a nutritious food because it contains several important nutrients including proteins and vitamins. Conversely, it can be a vehicle for several pathogenic bacteria such as Staphylococcus aureus. This study aimed to analyze the frequency of genes encoding the staphylococcal enterotoxins (SEs) SEA, SEB, SEC, SED, SEE, SEG, SEH, SEI and SEJ in S. aureus strains isolated from raw or pasteurized bovine milk. S. aureus was found in 38 (70.4%) out of 54 raw milk samples at concentrations of up to 8.9 X 10(5) CFU/ml. This microorganism was present in eight samples of pasteurized milk before the expiration date and in 11 samples analyzed on the expiration date. of the 57 strains studied, 68.4% were positive for one or more genes encoding the enterotoxins, and 12 different genotypes were identified. The gene coding for enterotoxin A, sea, was the most frequent ( 16 strains, 41%), followed by sec (8 strains, 20.5%), sed (5 strains, 12.8%). seb (3 strains. 7.7%) and see (2 strains, 5.1%). Among the genes encoding the other enterotoxins, seg was the most frequently observed (11 strains. 28.2%), followed by sei (10 strains) and seh and sej (3 strains each). With the recent identification of new SEs, the perceived frequency of enterotoxigenic strains has increased. suggesting that the pathogenic potential of staphylococci may be higher than previously thoughts however, further studies are required to assess the expression of these new SEs by S. aureus. and their impact in foodborne disease. The quality of Brazilian milk is still low. and efforts from the government and the entire productive chain are required to attain consumer safety. (C) 2008 Elsevier B.V. All rights reserved.

Quantifying Non-Tariff Measures for TTIP. Paper No. 12 in the CEPS-CTR project ‘TTIP in the Balance’ and CEPS Special Report No. 116/July 2015

This paper provides an overview of methods employed to quantify non-tariff measures (NTMs) and then analyses their differences and looks at what these mean for the Transatlantic Trade and Investment Partnership (TTIP) negotiations. The authors find several similarities in the approaches taken. Because all studies conclude that NTMs matter, they argue that policy-makers are right to focus on ‘regulatory cooperation’ in TTIP. Given the significant differences in NTMs across sectors, policy-makers are urged to dive deep into sector-specific elements of NTMs and focus on those sectors where the largest potential gains can be made (i.e. where NTMs are highest, such as in agriculture, automobiles, steel, textiles and insurance services). An area identified for further research is the fact that unlike trade taxes (i.e. tariffs), regulatory barriers to trade are not generally targeted as the primary policy objective, but rather stem from other strategic policy concerns such as consumer safety and/or social and environmental protection. This element should be further investigated.

Prescription drug samples: Does this marketing strategy counteract policies for quality use of medicines?

Prescription drug samples, as used by the pharmaceutical industry to market their products, are of current interest because of their influence on prescribing, and their potential impact on consumer safety. Very little research has been conducted into the use and misuse of prescription drug samples, and the influence of samples on health policies designed to improve the rational use of medicines. This is a topical issue in the prescription drug debate, with increasing costs and increasing concerns about optimizing use of medicines. This manuscript critically evaluates the research that has been conducted to date about prescription drug samples, discusses the issues raised in the context of traditional marketing theory, and suggests possible alternatives for the future.

Avaliação da viabilidade da aplicação de técnicas biomoleculares na autenticação de produtos alimentares

A carne continua a ser a fonte proteica mais comum no quotidiano das pessoas. Além disso, os produtos cárneos processados apresentam-se como uma mais-valia nas suas vidas agitadas. Este tipo de produto torna difícil a diferenciação das carnes utilizadas na sua confecção, sendo por isso propícios a adulteração. A Reacção em Cadeia da Polimerase (PCR) tem ganho cada vez mais importância nos laboratórios de biologia molecular, revelando-se uma técnica de análise rápida, sensível e altamente específica na identificação de espécies em produtos alimentares. No entanto, vários factores podem interferir com o processo de amplificação, pelo que alguns cuidados devem ser implementados desde a aquisição da amostra a analisar, ao seu acondicionamento e posterior extração de ADN. Existem inúmeros protocolos de extração de ADN, devendo para cada estudo avaliar-se e optar-se pelo mais adequado, considerando a finalidade estabelecida para a amostra extraída. O trabalho laboratorial apresentado nesta dissertação baseou-se em três etapas principais. Inicialmente, avaliaram-se diferentes protocolos de extração de ADN, utilizando-se amostras de carne adquiridas num talho. Entre os protocolos testados, o método de Brometo de Cetil-Trimetil-Amónio (CTAB) modificado foi o que permitiu obter amostras de ADN com maior concentração e elevado nível de pureza. Posteriormente, foram testados e optimizados diferentes protocolos de amplificação, por PCR em tempo real, para a detecção das espécies Bos taurus (vaca), Sus scrofa (porco), Equus caballus (cavalo) e Ovis aries (ovelha). Foram empregues primers específicos de espécie para a detecção de genes mitocondriais e genómicos, consoante cada protocolo. Para o caso concreto do porco, foi efectuada a avaliação de dois protocolos, singleplex com EvaGreen® e tetraplex com AllHorse, para possível aplicação dos mesmos na sua quantificação. Os resultados demonstraram elevada especificidade e sensibilidade das reacções para esta espécie, permitindo a sua detecção até um limite de 0,001 ng e 0,1%, respectivamente. Somente a primeira metodologia se mostrou adequada para quantificação. Por último, as metodologias sugeridas foram aplicadas com sucesso na análise de 4 amostras comerciais de hambúrgueres, tendo-se verificado a consistência da rotulagem em todos os casos, no que concerne a composição em termos de espécies animais. O interesse de trabalhos neste âmbito recai na importância da autenticidade dos rótulos de produtos alimentares, principalmente nos produtos cárneos, para segurança dos consumidores e salvaguarda dos produtores.

Development of procedures for the triazole fungicides determination in fruits and liquid samples using microextraction techniques and chromatographic separation

Agricultural crops can be damaged by funguses, insects, worms and other organisms that cause diseases and decrease the yield of production. The effect of these damaging agents can be reduced using pesticides. Among them, triazole compounds are effective substances against fungus; for example, Oidium. Nevertheless, it has been detected that the residues of these fungicides in foods as well as in derivate products can affect the health of the consumers. Therefore, the European Union has established several regulations fixing the maximum residue of pesticide levels in a wide range of foods trying to assure the consumer safety. Hence, it is very important to develop adequate methods to determine these pesticide compounds. In most cases, gas or liquid chromatographic (GC, LC) separations are used in the analysis of the samples. But firstly, it is necessary to use proper sample treatments in order to preconcentrate and isolate the target analytes. To reach this aim, microextraction techniques are very effective tools; because allow to do both preconcentration and extraction of the analytes in one simple step that considerably reduces the source of errors. With these objectives, two remarkable techniques have been widely used during the last years: solid phase microextraction (SPME) and liquid phase microextraction (LPME) with its different options. Both techniques that avoid the use or reduce the amount of toxic solvents are convenient coupled to chromatographic equipments providing good quantitative results in a wide number of matrices and compounds. In this work simple and reliable methods have been developed using SPME and ultrasound assisted emulsification microextraction (USAEME) coupled to GC or LC for triazole fungicides determination. The proposed methods allow confidently determine triazole concentrations of μg L‐1 order in different fruit samples. Chemometric tools have been used to accomplish successful determinations. Firstly, in the selection and optimization of the variables involved in the microextraction processes; and secondly, to overcome the problems related to the overlapping peaks. Different fractional factorial designs have been used for the screening of the experimental variables; and central composite designs have been carried out to get the best experimental conditions. Trying to solve the overlapping peak problems multivariate calibration methods have been used. Parallel Factor Analysis 2 (PARAFAC2), Multivariate Curve Resolution (MCR) and Parallel Factor Analysis with Linear Dependencies (PARALIND) have been proposed, the adequate algorithms have been used according to data characteristics, and the results have been compared. Because its occurrence in Basque Country and its relevance in the production of cider and txakoli regional wines the grape and apple samples were selected. These crops are often treated with triazole compounds trying to solve the problems caused by the funguses. The peel and pulp from grape and apple, their juices and some commercial products such as musts, juice and cider have been analysed showing the adequacy of the developed methods for the triazole determination in this kind of fruit samples.

Development of the Consumer Refrigerator Safety Questionnaire (CRSQ): A Measure of Consumer Perceptions and Practices

Food preparation and storage behaviors in the home deviating from the ‘best practice’ food safety recommendations may result in food borne illnesses. Currently, there are limited tools available to fully evaluate the consumer knowledge, perceptions and behavior in the area of refrigerator safety. The current study aimed to develop a valid and reliable tool in the form of a questionnaire (CFSQCRSQ) for assessing systematically all these aspects. Items relating to refrigerator safety knowledge (n=17), perceptions (n=46), reported behavior (n=30) were developed and pilot tested by an expert reference group and various consumer groups to assess face and content validity (n=20), item difficulty and item consistency (n=55) and construct validity (n=23). The findings showed that the CFSQCRSQ has acceptable face and content validity with acceptable levels of item difficulty. Item consistency was observed for 12 out of 15 refrigerator safety knowledge. Further, all five of the subscales of consumer perceptions of refrigerator safety practices relating to risk of developing foodborne disease food poisoning showed acceptable internal consistency (Cronbach’s α value > 0.8). Construct validity of the CFSQCRSQ was shown to be very good (p=0.022). The CFSQCRSQ exhibited acceptable test-retest reliability at 14 days with majority of knowledge items (93.3%) and reported behavior items (96.4%) having correlation coefficients of greater than 0.70. Overall, the CFSQCRSQ was deemed valid and reliable in assessing refrigerator safety knowledge and behavior and therefore has the potential for future use in identifying groups of individuals at increased risk of deviating from recommended refrigerator safety practices as well as the assessment of refrigerator safety knowledge, behavior for use before and after an intervention.

Consumer trust, risk and food safety: a review

Consumers' attitudes to trust and risk are key issues in food safety research and attention needs to be focused on clearly defining a framework for analysing consumer behaviour in these terms. In order to achieve this, a detailed review of the recent literature surrounding risk, trust and the relationship between the two must be conducted. This paper aims to collate the current social sciences literature in the fields of food safety, trust and risk. It provides an insight into the economic and other modelling procedures available to measure consumers' attitudes to risk and trust in food safety and specifically notes the need for future research to concentrate on examining risk and trust as inter-related variables rather than two distinct, mutually exclusive concepts. A framework is proposed which it is hoped will assist in devising more effective research to support risk communication to consumers.