Toilet anxiety: Panic about pooping in public

Debbie Schipp of reports that a condition which makes people too petrified to poo in public means some Australians avoid going out because they fear not only using public toilets, but are also scared they won’t make it in time.

toilet.anxietyAt its most extreme, toilet anxiety, shy bladder and shy bowel syndromes can be so crippling that sufferers stay home rather than risk peeing or pooing in public toilets.

And the fear people might hear you doing a number two is worse than that of doing a number one (pee) researchers from Swineburne University found when they developed a scale aimed at assessing the anxiety people commonly experience when needing to use a public rest room.

Dr Simon Knowles is one of the study’s authors, and a clinical psychologist who specialises in gastrointestinal conditions and working with people with severe anxiety about using public toilets. His said both Paruresis (anxiety associated with urinating in public: shy bladder) and Parcopresis (anxiety related to having a bowel motion: shy bowel) can be so extreme people can struggle to socialise, study or even hold down a job because they only feel comfortable using their own toilet.

The study involving 334 adults reveals that shy bladder and shy bowel symptoms were both associated with increased stress, anxiety and depression.

“Those who experience toilet anxiety frequently worry about using a public toilet due to fears that others may hear or see them,” Dr Knowles said.

“Although the prevalence of toilet anxiety is not clear, it is suggested to be around six per cent to 35 per cent of the population may be affected to some degree.”

Dr Knowles developed his scale of toilet anxiety measure in an effort to better understand the causes of the condition, and tested it on the 300-plus people involved in the study.

Basically, the ‘how scared are you to poo scale’ will help experts to better judge whether general self consciousness has spiralled into full blown social anxiety. If it’s the latter, Dr Knowles says, you’re far from alone, and it’s treatable.

The results of the research were recently printed in the Journal of Cognitive Behaviour and more information and the survey are available at

Watch and learn Maine: NJ health officials release info about hepatitis A exposure

A food handler from a New Jersey restaurant is in hospital recovering from hepatitis A. According to, the individual worked in the back of the house of Rosa’s Restaurant and Catering in Hamilton, NJ.

Health officials warned that anyone who ate at or catered from the restaurant between Nov. 10 and Monday may be at risk for developing Hepatitis A if they have not been previously vaccinated. The township received notification from the state Department of Health Monday. Township health officer Jeff Plunkett said the employee, who worked in food preparation, has been in the hospital since last Tuesday.Unknown-17-1

“It is contagious through the oral route when you ingest food so it’s a possibility that … you could contract the virus if he was handling your food at the time,” Plunkett said.

Unvaccinated individuals who ate there should receive an injection of immune globulin or Hepatitis A vaccine. Both can prevent an infection if given within 14 days of exposure.

This information is much more useful than what health folks in Maine said a couple of weeks ago.

Just market food safety at retail, government is hopeless: FSA plan to name and shame supermarkets selling Campylobacter chicken ditched after pressure from retailers

Maybe there’s something lost in translation; I’m barely starting to understand Australian.

chickenBut if I read this right, the piping hot UK Food Standards Agency has put retail over public health after scrapping plans to regularly name and shame supermarkets selling chicken contaminated with Campylobacter.

Lots of chuckles next time FSA proclaims they are a science-based agency.

According to the Daily Mail, FSA had promised to carry out regular surveys of chicken sold on the high street and publish the results, including the names of the stores, every three months.

The idea was that the public naming and shaming exercise would put pressure on the stores to clean up their chicken and reduce the food poisoning risk to customers.

However, the officials at the watchdog now want to scrap this idea and instead only publish data on the number of birds that are contaminated without identifying the stores involved.

The move has been condemned by a leading academic, who suggested it was driven by pressure from the industry and Government departments, who are keen support supermarkets, farmers and processors.

chicken.thermThe changes represent a major victory for the commercial interests of the big retailers, putting concerns for their sales and profits ahead of consumer safety and their right to know what they are eating.

The fact that the supermarkets have managed to water down the scheme is just the latest evidence as to how lobbying by big business has driven a change in official policy on food and health issues.

Similar lobbying killed off a plan for a blanket ban on junk food snacks and drinks from displays around supermarket check-outs.

The FSA recently revealed that more than one million people are falling victim to food poisoning every year with supermarket chicken named as the greatest threat.

Campylobacter, which is most often found on raw chicken, is the biggest cause of food poisoning in the country.

An official study published in 2009 revealed that two in three of all fresh chicken on shelves was contaminated with campylobacter. More than one in four – 27 per cent – were classed as being highly contaminated.

Despite the fact the FSA has asked supermarkets and farmers to make combatting campylobacter a top priority, the situation appears to have shown no improvement since then.

An FSA paper on the food poisoning caused by campylobacter warned: ‘In addition to the attendant economic costs, cases cause inconvenience, discomfort and misery to those who become infected and a small proportion of cases result in death or long-term consequences, such as reactive arthritis, irritable bowel syndrome and Guillain-Barré syndrome, the latter of which affects the peripheral nervous system.’

Despite the clear threat, the FSA’s executives are now asking its board to redraw the rules for its surveys to ensure the stores selling contaminated chicken are not identified in its quarterly results.

A paper prepared by officials states this is in response to ‘legitimate concerns expressed by the industry and other government departments’. The references to other departments relates to the food and farming department, DEFRA, which sees itself as a champion of British farmers, including those producing chicken.

The FSA paper states: ‘In the last update to the Board in March 2014 it was stated that the FSA intended to release the full results, including the names of the retailers and processors, of testing of around 1,000 samples every 3 months during the survey, with the first results published around June/July 2014.’

However, it says it has now decided to change this approach because there is a risk the results will be incomplete and misleading and it would – in some way – be unfair to the stores.

The FSA said: ‘One of the drawbacks of this approach is that no interpretation can properly be placed on interim raw data until the full year’s sampling is complete and fully analysed.

The watchdog’s board is being asked to approve this new approach at a meeting tomorrow.

Erik Millstone, the Professor of Science Policy at the University of Sussex, condemned the move to let the supermarkets off the hook.

Regulators mount up: raw milk producers aim to regulate themselves

I don’t care who does the regulating as long as the data is public, verifiable and producers are liable. There are benefits and faults with the many systems out there that could be largely remedied with public access to data and marketing of microbial food safety at retail.

colbert.raw.milkAnd I’m sure the raw milk producers promoting self-regulation would have no problem with genetically engineered foods, meat and restaurants being self-regulated.

At least I’m consistent.

Deena Prichep of NPR’s The Salt reports that Mark McAfee, the CEO of Organic Pastures, California’s largest raw milk dairy has founded the Raw Milk Institute.

“People are searching for local raw milk,” McAfee explains. “But when they go to the farm, or they go to the store, they really don’t know what they’re getting.”

To create both accountability and transparency, McAfee worked with epidemiologists, biologists and other health professionals to create RAWMI’s standards. Instead of just focusing on the end results, like bacteria levels, they also worked up detailed protocols for the entire process — from taking the temperature of the dishwasher used to clean the milk bottles to the distance between the water well and manure pile.

The group is also looking at the risk specific to each farm, whether it’s a muddy slope with three cows in Oregon or a sunny California farm with a midsize herd.

When a farm completes its hazards analysis, planning and testing — and passes a site visit from RAWMI — it is listed on the institute’s website. Right now there are half a dozen farms listed, with 10 more in the midst of the process.

The first farm to be listed was Champoeg Creamery, a small dairy about 30 miles south of Portland, Ore. Owner Charlotte Smith is a fifth-generation farmer. But when she first started producing raw milk a few years ago, she discovered it was an entirely different animal.

“I could call the extension office, and get some help on what was going on with my vegetables, or what is this beetle eating my tomatoes,” says Smith. “But there’s no one that will help you with raw milk production.”

And with about 100 families buying her milk — and monitoring an E. coli outbreak at a neighboring farm that landed kids in the hospital — Smith was committed to getting it right. Because while Smith says raw milk may offer health benefits, she also acknowledges the very real dangers.

“You can bring home a chicken and sell the eggs, and feel pretty safe about it. But raw milk, coming out of a cow, and manure flying during milking time — it is a huge challenge, far different than any other farm animal we have.”

As someone looking for guidance, Smith was a bit surprised that national regulatory agencies wouldn’t lend their expertise to establishing safety criteria. To them, she says:

“Raw milk is here to stay, whether you want to admit it or not. So why not work together, come up with some very basic things, where if you’re going to produce and sell raw milk, you’re going to agree that you have met these standards. In my mind, it seems so easy.”

Robert Tauxe at the Centers for Disease Control and Prevention says that while the safety plans and regular testing advocated by RAWMI can certainly reduce the risk of bacterial contamination, they can’t offer any certainty that the particular gallon you grab from the shelf is truly safe.

“A cow can test negative today, and then get infected tomorrow,” notes Tauxe.

Tauxe is not unsympathetic to the reasons people seek out raw milk. “I understand the interest in having colonies of living bacteria in the food we eat,” he says. “The problem is when those living bacteria that are beneficial get mixed up with the living bacteria that cause disease.”

Asking questions at the farmers’ market

Screen Shot 2014-06-06 at 8.46.11 AMA couple weeks ago I took my kids to the farmers’ market. Sam, who is 3, is all about food shopping: picking out what the family will be eating while trying to convince me to buy him treats and snacking on the free samples. While Jack and Dani were looking at plants for our gardens, Sam and I toured the food stalls. We came upon a vendor selling cider (right, exactly as shown).

Worrying more about my kids safety than looking like a nerd, I asked, “Is it pasteurized?”

The dude at the stall answered, “It sure is, flash pasteurized to keep it safe.”


My friend Judy Harrison writes in this month’s Food Safety Magazine that farmers’ markets continue to increase as a place for folks to connect with their food.

Visiting with your neighbors, listening to live music while shopping, meeting the farmer who grew the produce, sampling the fresh food in the market, the festival-like atmosphere…that is the downhome feel that has Americans flocking to farmers markets.

Who are the customers shopping at these markets? It takes only a trip on an early Saturday morning to see that many of the customers are senior adults, people who may have health problems and mothers with young children all shopping for foods they perceive to be healthier and safer than those you buy in the grocery store. What is often casually observed is an attitude, not just among consumers but among farmers and market managers as well, that “It’s locally grown…I know that farmer…It’s organic…so it is healthier and safer than what I could get at the store.”

If you took a tour of your local farmers market, what would you see? Many local markets are held in open fields in city parks or even in parking lots. Conditions may be less than sanitary. You are likely to observe fruits and vegetables displayed on the ground rather than being held at least six inches above this surface, as would be required in food storage areas of restaurants or grocery stores. You are also likely to encounter customers or even vendors bringing their dogs into the market area and having access to displays. You may or may not see handwashing facilities or at least hand sanitizer being provided in the market. Some of the produce may already be packaged in open bags for customers to pick up, or customers may be allowed to handle and select their own produce. You may even see stations where customers can bring produce they have just purchased to be juiced or blended into healthy shakes—with no evidence of facilities for washing produce, hands or equipment. You may see displays where customers can sample cut produce that is not being kept on ice or refrigerated. You may also see entrepreneurs who are making and selling food products that you hope are at least following cottage food regulations. As a food safety professional, you see opportunities for increased risk of foodborne illness.

Judy’s comments are bang-on, lots of people shop at the farmers market, have various perceptions and may not see the world through the eyes of a food microbiologist. The conversation I had with the cider vendor led me to revisit a project idea we’ve had steeping for a while: what questions do I ask at the farmers’ market – and what do I think the answers should be? Stuff like what does the producer do to evaluate the safety of the water they use, do they use composted manure, how do they handle ill staff who show up to pick?

Screen Shot 2014-06-06 at 9.07.26 AM

I have linked a draft of a document that captures those questions and more and I’m asking the online food safety nerds to share additional thoughts and questions to make the document more robust. Feel free to add a comment here on the blog, tweet @benjaminchapman, post a comment on our Facebook page or use old fashioned e-mail.



Data? You can’t handle data; trust us we’re doing better

In 2012, XL Foods in Alberta sickened at least 18 people with E. coli O157:H7, and led to the largest beef recall in Canadian history; the huge slaughterhouse was subsequently bought by JBS of Brazil.

An independent review panel concluded the outbreak was cause by mediocrity both at the plant and government overseers.

So when the new Canadian president for JBS told an ol’ timey meet-and-greet tour he wouldn’t reveal E. coli incidence rates and you.cant.handle.truththat the Canadian Food Inspection Agency has that figure and JBS is accountable to them, it doesn’t inspire confidence.

Van Solkema said now, six months after the change of ownership, there are four times fewer positive E. coli samples showing up in in-plant tests.

Alberta Liberal health critic Dr. David Swann — who visited the plant under its previous ownership when he was Medical Officer of Health — told the Calgary Herald in general, he was impressed by what he saw Friday.

But Swann also seems to get it, that to build trust and have consumers buy a product, some are going to want to know things, like how often the production line needs to be slowed or halted for one reason or another, how many samples test positive for E. coli contamination, and how much meat is thrown away each month.

“We need to have some kind of objective measures to say this is a safer plant or a safer product than any others,” Swann said. “We need more numbers — injury rate, E. coli rate, throwaway rate, and high-speed line infraction. That would be helpful for everybody, to know that the plant is operating at high levels.”

Having a slaughterhouse president and government inspectors say they are doing a bang-up job, in the absence of any public data, is meaningless.

The JBS plant at Brooks has 2,400 employees and processes 3,800 cattle each day. The plant produces 250 different beef products — the majority of which is shipped to Canadian customers. Beef from Brooks also goes to other markets, including the U.S., Mexico, Egypt, and Asia.


229 sick; norovirus caused cheerleader illness outbreak; don’t barf in public or at least clean it up

Last week, some 300 staff and students in San Francisco were sickened with norovirus believed to have been transmitted by someone barfing on a door handle.

It now appears a similar mode of transmission sickened 229 cheerleaders and cheeries at a Washington state competition.

JoNel Aleccia of msnbc cites Suzanne Pate, spokeswoman for the Snohomish Health District, as confirming Friday that norovirus was the cause, and the outbreak was likely precipitated by people who were ill in public.

"Somebody arrived at the event sick," said Pate, noting that janitorial crews were called to clean up vomit in a restroom and on an adjacent walkway. Those areas were likely exposure sites for the cheer and dance teams, she said.

Some 229 people were sickened and least 33 people sought medical attention for their illnesses, state health officials said late Friday. That number is expected to grow as the investigation continues.

A Comcast Arena spokeswoman said officials had sanitized the premises in accordance with federal health guidelines before a new event scheduled for Friday night. Tests of the arena’s water supply showed no problems, Pate said.

"It’s probably the best-scrubbed place in the county," she added.

Slaughterhouse 5, as in 5 stars; NRC committee finds releasing inspection and testing data on meat and poultry processing facilities with care could have ‘substantial benefits’

 Billy Pilgrim has come unstuck in time.

Wrong lede.

“Publicly posting enforcement and testing data corresponding to specific meat, poultry, and egg products’ processing plants on the Internet could have "substantial benefits," including the potential to favorably impact public health, says a new report from the National Research Council. The report adds that the release of such data could contribute to increased transparency and yield valuable insights that go beyond the regulatory uses for which the data are collected.”

The report gets a lot of things right, especially the decades-long move to more transparency in U.S. regulatory functions, whether it’s food safety, environmental pollution or energy generation. No one wants to be on the wrong side of history, the democratization of institutions, so best to provide taxpayer-funded information, and figure out the most effective way to provide such information, rather than being the politician or group that says, “no.”

The committee notes that, just like restaurant inspection disclosure, “releasing these data could potentially motivate individual companies, and sectors of the food industry, to improve their overall food safety efforts,” and that such publicly available date could, “provide incentives to food processing establishments to protect brand reputation in food safety in order to protect and enhance customer base and profitability.”

If only consumers could choose at retail.

The press release announcing the report’s findings is below.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is responsible for ensuring that meat, poultry, and processed egg products are safe, wholesome, and properly labeled. It collects voluminous amounts of data at thousands of processing facilities in support of its regulatory functions and is considering the release of two types of collected data on its website. These include inspection and enforcement data and sampling and testing data — such as testing for the presence of foodborne pathogens like salmonella, pathogenic E. coli, and Listeria monocytogenes. Some of this information is already available to the public via the Internet but is aggregated and does not contain names of specific processing facilities. However, most of the data FSIS collects, with the exception of information that is considered proprietary, can currently be obtained by the public through the Freedom of Information Act (FOIA).

The committee that wrote the report examined a substantial body of literature documenting the impacts of disclosing establishment-specific regulatory information similar to that collected by FSIS. Based on this information, the committee believed there are strong arguments supporting the public release of FSIS data that contains the names of processing facilities on the Internet, especially data that are subject to release under FOIA, unless there is compelling evidence that it is not in the public interest to release them. Several potential benefits of releasing such data include enabling users to make more informed choices, motivating facilities to improve their performance, and allowing research studies of regulatory effectiveness and other performance-related issues. More specific benefits might include better understanding on the part of the public relative to the kinds of information that have been collected, such as a greater appreciation for the quality, complexity, and potential usability of the data for specific purposes. Even if individual firms do not change their behavior in response to data posting, overall food safety could improve if information about performance leads consumers to favor high-performing facilities, effectively resulting in a shift in the composition of the market.

The benefits of releasing FSIS data must be balanced against potential unintended adverse consequences, the report says. These could include impacts on facilities’ profitability, possible misinterpretation of the data, pressure on inspector performance, and unintentional release of proprietary or confidential information. However, the committee concluded that while adverse impacts are possible, there is limited systematic evidence documenting their likelihood.
Because of the complexity of issues associated with public release of data with facility names and the potential for adverse effects, the report suggests the need for an effective disclosure plan to inform the process. For example, potential adverse effects could be minimized if FSIS ensures the data’s integrity, provides definitions of what is being quantified, and is careful to protect confidential information associated with particular facilities. To help make sure that the public release of the data will be useful, the committee suggested that FSIS define a timetable for its release and commit the resources necessary to allow the data’s accessibility, quality, and timeliness.

Additionally, the report recommends that FSIS consult with other agencies that have released detailed regulatory data on the performance of individual facilities or firms, such as the U.S. Environmental Protection Agency’s Enforcement and Compliance History Online (ECHO), the U.S. Department of Labor’s Mine Safety and Health Administration, and several states and local public health departments that have released data on restaurant hygiene and inspection grading.

Below is one of our contributions to providing such public information.

So it goes.

Filion, K. and Powell, D.A. 2009. The use of restaurant inspection disclosure systems as a means of communicating food safety information. Journal of Foodservice 20: 287-297.
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.

Chicago politico says public may not understand restaurant inspection results

 For over a decade, I’ve ben hearing how the public – whoever that is – may not understand restaurant inspection results.

There’s only a couple of things I tell my kids, especially the 3-year-old: anyone who says, “trust me” is immediately untrustworthy, and anyone who claims to be speaking on behalf of the public, or all Americans or all Canadian women is only talking about themselves (I also tell the kids to keep your stick on the ice and don’t take wooden nickels).

CBS reports that as the City of Chicago has rolled out a new Web site with thousands of restaurant inspection results online, alderman Tom Tunney, who is a restaurant owner himself, says some people may get the wrong impression.

The point that Tunney makes is that the inspection reports online require a little study and not just a glance.

Then do some research and figure out what people and food service operators want instead of saying how hard it is.

E. coli O157 linked to leeks sickens 250 and kills 1 in UK; 8-month outbreak only now being made public

An eight-month E coli O157:H7 phage-type 8 outbreak across the U.K. that left 250 people ill and one dead was not publicized at the time because its origins were unknown.

After six months of investigations the infection was ultimately linked to people handling loose raw leeks and potatoes in their homes, said the Health Protection Agency (HPA), which has only now acknowledged the outbreak.

The cases began last December and continued until July. In total 250 victims – 100 of them under 16 – were left sick with vomiting and diarrhea. Of those, 74 needed hospital treatment. One unnamed patient, who the HPA said had underlying health problems, died.

In each of the past three years an average of 81 people across the U.K. have been infected with E coli O157 PT8.

"Our study showed a statistically significant association with raw loose leeks and potatoes from sacks, but these vegetables may not be the only source of contamination," said Dr Bob Adak, an HPA gastrointestinal expert who led the multi-agency outbreak control team that investigated it.

Soil on the vegetables is thought to have been the likely source of the E coli bacteria. "In this outbreak, which is now over, the vegetables could have carried traces of contaminated soil. It is possible people caught the infection from cross-contamination in storage, inadequate washing of loose vegetables, insufficient hand washing after handling the vegetables or by failing to thoroughly clean kitchen equipment, utensils or surfaces after preparing the vegetables."

A spokeswoman said the HPA did not alert the public to the ongoing outbreak because they did not know where it had originated and therefore could offer no useful public health advice.

And the sanitized press release nonsense ends here.

Potato and leek soup is a standard in my kitchen, using chicken stock made from the weekly roast chicken.

I’m not sure what else leeks are used for, and they can contribute to some fantabulous gas, but they are a mess to clean: dirt and soil is engrained throughout the white part of the vegetable. I give them a rinse under tap water and then slice for soup. But the risk is with cross-contamination – leeks are grown in soil and whatever microorganisms are within the white bits are going to drip on the counter and elsewhere.

Be the bug, follow the bug.

The folks at the U.K. Food Standards Agency whose idea of science-based verification is to cook meat until it is piping hot, have apparently decided that E. coli O157:H7 – the dangerous kind – found on or in leeks, is the consumers’ responsibility.

"This outbreak is a timely reminder that it is essential to wash all fruits and vegetables, including salad, before you eat them, unless they are labeled ‘ready to eat’, to ensure that they are clean. It is also important to wash hands thoroughly as well as clean chopping boards, knives and other utensils after preparing vegetables to prevent cross contamination,” said Dr Andrew Wadge, chief scientist at FSA.

No questions about what E. coli O157:H7 is doing on so many potatoes and leeks that 250 people get sick.

The Brits are so bad at communicating basic food safety information that FSA put out its own press release stressing the need for home hygiene because of “two recent E.coli outbreaks,” referring to the leeks and the German-based E. coli O104 sprout outbreak earlier this year which killed 53 and sickened over 4,000. People could have washed sprouts all they liked but it wouldn’t have done anything to control E. coli, especially if it was originally in the Egyptian seed, as is widely suspected.

Consumers, you are apparently the critical control point for microorganisms that will rip out your kidneys: FSA says, those leeks and potatoes, “although safe to eat if handled correctly, could have had soil on them containing harmful bacteria.”

Despite decades of food safety communication case studies and research to the contrary, the Brits are intent on forging their own top-10 stupid ways to talk about foodborne illness, with special mention to mad cow disease, salmonella in eggs and proper cooking temperatures.

If U.K. food and health types have a communications policy, it seems to be one of, no positive food, no public statement, no matter how many are dead or dying.

Why not say, as many other jurisdictions do, that an increase in a type of rare but dangerous E. coli has been noted, we’re not sure where it came from, but we’re trying to figure things out, and as soon as we know more, you’ll hear it first from us.

Is there any policy on providing the public with information about foodborne illness in the U.K.?

Stay comfortably numb (there’s a better vid of gilmore and waters earlier this year at