Week of July 6 Flashcards
You are the MOH of a large urban health unit. You have just been informed that an unknown contaminant was accidentally introduced into a batch of beers at a craft brewery. The batch of beers was shipped out two weeks ago. List steps that you would take to reduce the public risk.
Initiate a food safety investigation and recall process
CFIA process
- Conduct a product safety investigation
- Conduct a health risk assessment
- Initiate a recall process
- Implement the call process
- Inform the public
- Ongoing follow up
- Work collaboratively with provincial and federal stakeholders including the Canadian food Inspection Agency
- Conduct a health risk assessment of the contaminant
- Issue a recall on the contaminated product if required
- Conduct a safety investigation and ensure adequate steps take to prevent ongoing contamination / future contamination
- Inform the public
Describe the three classes of risk that can be assigned for a food recall
Class I (high risk): There is a high risk that eating or drinking the food product will lead to serious health problems or death.
Class II (moderate risk): Eating or drinking the food product will most likely lead to short-term or non-life threatening health problems. The chance of any serious health symptoms is low in healthy populations.
Class III (low and no risk): Eating or drinking the food product will not likely result in any undesirable health effects. This category can include food products that pose no health and safety risk, but do not comply with relevant laws (e.g. a product has more than the allowed level of an additive or preservative).
What are 6 triggers for a food safety investigation?
- Outbreak of illness
- Food test result
- CFIA inspection finding
- Consumer complaint
- Company initiated
- Recall in other country
You are a MHO. You have received a report of 3 children with bloody diarrhea who all attend the same boarding school. List 8 steps that you would take in the management of this report.
- Confirm outbreak and diagnosis
- Consider immediate control measures
- Assemble an outbreak response team
- Establish case definition - PPTLS (standard set of criteria for determining if a person should be classified as part of an outbreak, such as lab diagnosis, symptoms, person, place, and time; may be divided into confirmed, probable, and suspect/possible)
- Identify cases and contacts (line list), and obtain information
Organize data in terms of person, place, and time (descriptive epidemiology)
Define the population at risk
Develop and test hypotheses
Implement control measures: The chosen control strategies should take into account epidemiology, study findings, environmental sampling, and theory; practically, control strategies will also be influenced by jurisdictional authority, legal roles, political sensitivity, timeliness of outbreak detection, interpersonal issues, and available resources
Monitor the response
Summarize in a report
List two types of study designs used in the investigation of food borne outbreaks, provide an example of when you would use each type, provide the measure of association you would calculate.
Retrospective cohort study. Useful when small, well-defined population, such as an outbreak of gastroenteritis among wedding guests for which a complete list of guests is available.
- the investigator calculates an attack rate for those exposed to (e.g., who ate) a particular item and an attack rate for those who were not exposed.
Case- control. Useful when attempting to determine cause of outbreak in large poorly defined population. For example, much larger number of salmonella cases observed in a health unit than normal for that time period.
Case-patients and a comparison group of persons without disease (“controls”) about their exposures.
Your outbreak investigation identifies two plausible food exposures that may have resulted in the outbreak. What are three factors that suggest a particular food item is the source of an infection is a gastroenteritis outbreak?
The attack rate is high among those exposed to the item.
The attack rate is low among those not exposed, so the difference or ratio between attack rates is high.
Most of the case-patients were exposed to the item, so that the exposure could “explain” or account for most, if not all, of the cases.
You are conducting an investigation of 14 members of the general public who have all developed Verotoxin producing e.coli. You have determined that you will do a case control study to identify a potential exposure. List three ways that you might identify controls.
- In a community outbreak, a random sample of the healthy population is the best control group
Alternative include
- Neighbours of case-patients
- Patients from the same physician practice or hospital who do not have the disease in question,
- Friends of case-patients who they have not recently seen
What are 8 organisms that can be transmitted through meat?
- Staph Aueus
- Brucellosis
- E.coli
- Salmonella
- Campylobacter
- Trichella
- Listeria
- Toxoplasmosis
What are 4 organisms that can be transmitted through unpasteurized milk?
Salmonella E. coli Listeria Campylobacter Brucellosis Cryptosporidium
What are four categories of hazards that can be found in food. list an example for each
Biological - presence of bacteria such as e.coli
Physical - presence of foreign bodies from food processing or contamination. Ex, small glass fragmenets
Chemical - mercury found in marine animals through bioaccumulation
Allergenic Hazards - contamination with an allergen containing food such as peanuts
List 5 types of chemical hazards that can be present in food
Mycotoxins Natural Toxins Marine Toxins Environmental Contaminants Food Additives Processing-induced chemicals Pesticides/Agricultural Products and Veterinary Drug Residues
You are a MOH and are reviewing the annual budget for your health unit. List 4 steps you would take in preparing the budget for review by your board of health
gather information
understand each line item
predict the future (revenues and expenditures)
review the results
finish the budget
add assumptions
check numbers
present
Describe three types of budgeting strategies?
- Zero based budgeting (bottom up) - New budget is based on the justification of the expense, regardless of the amount budgeted in previous years (i.e., no base taken into account)
- Incremental budgeting (historical) - New budget is the product of incremental, small changes to the previous budget
- Marginal Analysis
a) review and analyze budget for each program area
b) identify programs that could cut funding without significant loss in function
c) identify programs that could improve substantially with more funding
d) allocate money from b to c
What are three functions of a budget?
- Transparency and accountability (Performance Monitoring)
- Prioritization and planning (Decision Making)
- Control and monitoring of spending (Accounting)
Name 5 types of validity and describe them
Content Validity - did the study measure the right things? I.e. for depression did it capture all aspects of depression or just some?
Construct Validity - did the study accurately measure the things it wanted to study
Criterion Validity - how well does the test compare to an established measure or predict the desired outcome. E.g. does a score on this test accurately predict future smoking
Internal Validity - degree of confidence that the causal relationship being tested is trustworthy and not influenced by other factors or variables.
External Validity - extent to which results from a study can be applied (generalized) to other situations, groups or events.
