Journal of Preventive Medicine and Public Health

Systematic Review

Food is Medicine Initiative for Mitigating Food Insecurity in the United States: Vidya Sharma, Ramaswamy Sharma; J Prev Med Public Health. 2024;57(2):96-107. Published online March 8, 2024; DOI: https://doi.org/10.3961/jpmph.23.505

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Abstract Summary PDF: Objectives
While several food assistance programs in the United States tackle food insecurity, a relatively new program, “Food is Medicine,” (FIM) initiated in some cities not only addresses food insecurity but also targets chronic diseases by customizing the food delivered to its recipients. This review describes federal programs providing food assistance and evaluates the various sub-programs categorized under the FIM initiative.
Methods
A literature search was conducted from July 7, 2023 to November 9, 2023 using the search term, “Food is Medicine”, to identify articles indexed within three major electronic databases, PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligibility criteria for inclusion were: focus on any aspect of the FIM initiative within the United States, and publication as a peer-reviewed journal article in the English language. A total of 180 articles were retrieved; publications outside the eligibility criteria and duplicates were excluded for a final list of 72 publications. Supporting publications related to food insecurity, governmental and organizational websites related to FIM and other programs discussed in this review were also included.
Results
The FIM program includes medically tailored meals, medically tailored groceries, and produce prescriptions. Data suggest that it has lowered food insecurity, promoted better management of health, improved health outcomes, and has, therefore, lowered healthcare costs.
Conclusions
Overall, this umbrella program is having a positive impact on communities that have been offered and participate in this program. Limitations and challenges that need to be overcome to ensure its success are discussed.; Summary

Key Message
In 2023, the United States Department of Health & Human Services (HHS), developed a "Food is Medicine" (FIM) initiative to address food insecurity and chronic diseases by providing healthy food options tailored to recipients' specific health needs. Programs categorized under the FIM initiative include Medically Tailored Meals, Medically Tailored Groceries, and Produce Prescriptions, which are described in this review. Overall, the program appears to have had a positive impact by improving health outcomes and enhancing the overall quality of life.

Original Articles

Crossover Food Businesses in Louisiana, United States: A Descriptive Study of Their Characteristics and Food Safety Training Needs From Public Health Inspectors’ Perspective: Wenqing Xu, Evelyn Watts, Carolyn Bombet, Melissa Cater; J Prev Med Public Health. 2022;55(3):289-296. Published online May 20, 2022; DOI: https://doi.org/10.3961/jpmph.22.013

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Objectives
Integrating retail and manufacturing enables limitless potential for food businesses, but also creates challenges for navigating within complex food safety regulations. From public health inspectors’ (PHIs) perspective, this study aimed (1) to describe the characteristics of crossover businesses in Louisiana, and (2) to evaluate regulation awareness and food safety education needs for business owners and PHIs who inspect crossover businesses.
Methods
A self-administered questionnaire was administered to Louisiana Department of Health PHIs using Qualtrics®. A descriptive analysis was performed, focusing on the frequency of each item.
Results
In total, 1774 retailers were conducting or planned to conduct specialized processes, while 552 food manufacturers were performing or planned to perform retail functions. Reduced oxygen packaging, the use of additives such as vinegar as a method of preservation, and smoking food as a method of preservation were observed by 62%, 36%, and 35% of the PHIs, respectively. The PHIs perceived crossover businesses as “not aware” or “somewhat aware” of the food safety regulations. The current food safety training level for these businesses was reported to range from “no training” to “some training but not sufficient.” When asked for a self-assessment, the majority of PHIs reported themselves as being “familiar” with the variance requirement for specialized processing. Their confidence in inspecting crossover businesses, however, leaned towards “not confident” or “somewhat confident.”
Conclusions
To better guard public health, food safety training is needed for crossover food business owners, as well as PHIs, on regulations and conducting or inspecting specialized processes.

Summary

Citations

Citations to this article as recorded by

Food is Medicine Initiative for Mitigating Food Insecurity in the United States
Vidya Sharma, Ramaswamy Sharma
Journal of Preventive Medicine and Public Health.2024; 57(2): 96. CrossRef

Association Between the Frequency of Eating Non-home-prepared Meals and Women Infertility in the United States: Sohyae Lee, Jin-young Min, Hye-Jin Kim, Kyoung-bok Min; J Prev Med Public Health. 2020;53(2):73-81. Published online February 10, 2020; DOI: https://doi.org/10.3961/jpmph.19.218

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Abstract Summary PDF

Objectives
The purpose of this study was to determine whether eating non-home-prepared meals (NHPM), including fast food, ready-to-eat foods, and frozen foods, was associated with self-reported infertility in the United States women. Methods: Data on diet and infertility from women aged 20-49 years who participated in the 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys were analyzed (n=2143). Dietary information, including the number and types of NHPM consumed, was obtained from a self-reported questionnaire, and infertility status was analyzed using the following question, “Have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?” Results: The frequency of NHPM consumption was positively associated with self-reported infertility after adjusting for confounding effects (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.48 to 5.38 of >1 vs. 0 NHPM/d). The odds of infertility were 2-3 times higher in women who consumed fast food than in those who did not consume fast food (OR, 2.73; 95% CI, 1.15 to 6.48 of >1 vs. 0 times/d). Conclusions: The frequency and types of NHPM may be a factor contributing to infertility. Although our findings require confirmation, they suggest that eating out may be deleterious to women fecundity.

Summary

Korean summary
본 연구에서는 미국 국민건강영양조사 자료를 사용하여 패스트푸드, 냉동식품, 그리고 포장하여 판매하는 음식과 같이 집에서 조리하지 않은 음식 섭취와 불임의 연관성을 분석하였다. 잠재적인 교란변수들을 통제하여 분석한 결과 집에서 조리하지 않은 음식 섭취 횟수는 불임과 연관이 있는 것으로 나타났다 (OR 2.82, 95% CI 1.48 to 5.38 of >1 vs. 0 NHPM/d).

Citations

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Assessing the influence of preconception diet on female fertility: a systematic scoping review of observational studies
Simon Alesi, Nahal Habibi, Thais Rasia Silva, Nicole Cheung, Sophia Torkel, Chau Thien Tay, Alejandra Quinteros, Hugo Winter, Helena Teede, Aya Mousa, Jessica A Grieger, Lisa J Moran
Human Reproduction Update.2023; 29(6): 811. CrossRef
Environmental factors in declining human fertility
Niels E. Skakkebæk, Rune Lindahl-Jacobsen, Hagai Levine, Anna-Maria Andersson, Niels Jørgensen, Katharina M. Main, Øjvind Lidegaard, Lærke Priskorn, Stine A. Holmboe, Elvira V. Bräuner, Kristian Almstrup, Luiz R. Franca, Ariana Znaor, Andreas Kortenkamp,
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Impact of Ready-Meal Consumption during Pregnancy on Birth Outcomes: The Japan Environment and Children’s Study
Hazuki Tamada, Takeshi Ebara, Taro Matsuki, Sayaka Kato, Hirotaka Sato, Yuki Ito, Shinji Saitoh, Michihiro Kamijima, Mayumi Sugiura-Ogasawara
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Food Security in Households of People Living With Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: A Cross-sectional Study in a Subdivision of Darjeeling District, West Bengal: Pallabi Dasgupta, Sharmistha Bhattacherjee, Dilip Kumar Das; J Prev Med Public Health. 2016;49(4):240-248. Published online July 19, 2016; DOI: https://doi.org/10.3961/jpmph.16.023

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Abstract PDF

Objectives
Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) adversely impacts food security in households of people living with HIV/AIDS (PLWHA). Little research has focused on food insecurity among PLWHA in India. The purpose of this study was to identify the prevalence of and factors relating to food security in households of PLWHA in the Siliguri subdivision of Darjeeling, West Bengal, India.
Methods
A cross-sectional community-based study was carried out among 173 PLWHA residing in Siliguri and registered at the Anti-retroviral Therapy Centre of North Bengal Medical College & Hospital. Data was collected at the household level with interviews of PLWHA using a food security survey instrument. We analyzed the associations using logistic regression.
Results
The prevalence of household food security among the participants was 50.9% (88/173). Five years or more of schooling, higher socioeconomic class and males were found to be significantly associated with a higher likelihood of food security. A later stage of the disease and the presence of other family members with HIV/AIDS were significantly associated with a lower likelihood of food security. The major coping strategies to deal with food insecurity in the acute phase HIV infection included borrowing money (56.1%), followed by spousal support, loans from microfinance institutions, banks, or money lenders, borrowing food, or selling agricultural products.
Conclusions
The present study revealed that only about half of households with PLWHA were food secure. Prior interventions relating to periods of food and economic crisis as well as strategies for sustaining food security and economic status are needed in this area.

Summary

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Differences in the Levels of Gastric Cancer Risk Factors Between Nanjing and Minqing Counties, China: Xiang-Quan Xie, Kui-Cheng Zheng, Bing-Shan Wu, Tie-Hui Chen, Shan-Rong Lai, Zai-Sheng Lin, Kazuo Aoki; J Prev Med Public Health. 2014;47(5):281-287. Published online September 12, 2014; DOI: https://doi.org/10.3961/jpmph.14.018

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Abstract PDF

Objectives
In Fujian Province, China, gastric cancer is one of the leading causes of mortality among all malignant tumors. Nanjing county and Minqing county are located in inland Fujian and have similar general demographics. However, the adjusted mortality rate of gastric cancer in Minqing was found to be much higher than that in Nanjing. We sought to explore factors associated with this increased risk of gastric cancer between the two counties. Methods: We recruited 231 and 224 residents from Nanjing and Minqing, respectively, and analyzed differences between their dietary habits, Helicobacter pylori infection rates, and concentrations of serum pepsinogen I, pepsinogen II, gastrin-17, and ratio of pepsinogen I:II. Results: Subjects in Minqing had more first-degree relatives who had been diagnosed with upper gastrointestinal tumor, more unhealthy dietary habits, a higher Helicobacter pylori positive rate, and greater proportion of abnormal serum gastrin-17 than those in Nanjing did. Conclusions: The factors that differed between these two counties might indicate that residents in Minqing have a higher risk for developing gastric cancer than those in Nanjing do.

Summary

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Special Article

Food Ingestion Factors of the Korean Exposure Factors Handbook: Jae-Yeon Jang, Soo-Nam Jo, Sun-Ja Kim, Hyung-Nam Myung, Cho-Il Kim; J Prev Med Public Health. 2014;47(1):18-26. Published online January 29, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.1.18

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Abstract PDF

The purpose of this study was to establish food ingestion factors needed to assess exposure to contaminants through food ingestion. The study reclassified the raw data of the Korean National Health and Nutrition Examination Survey in 2001 into 12 subcategories including grain products, meat products, fish and shellfish, and vegetables for international comparability of exposure evaluation. The criteria for food intake calculation were unified according to the characteristics of food groups, and recommended values for food ingestion factors were calculated through moisture correction and recategorization of cooked, processed, and mixed foods for each group. The average intake rate for grain and grain products was 6.25 g/kg-d per capita and the men's intake rate was approximately 8% higher than that of the women. The average intake rate of meat and meat products was 1.62 g/kg-d per capita and the men's intake rate was 30% higher than that of the women, on average. The average intake rate of fish and shellfish was 1.53 g/kg-d per capita, and the age groups of 1 to 2 and 3 to 6 recorded higher capita intake rates than other age groups, 2.62 g/kg-d and 2.25 g/kg-d, respectively. The average intake rate of vegetables was 6.47 g/kg-d per capita, with the age group of 1 to 2 recording the highest per capita intake rate of 9.79 g/kg-d and that of 13 to 19 recording the lowest mean. The study also offers recommended values for food ingestion factors of other food groups by gender, age, and region. The food ingestion exposure factors will need future updates in consideration of ongoing changes in food consumption behavior.

Summary

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Original Article

Changes in Dietary Behavior Among Adolescents and Their Association With Government Nutrition Policies in Korea, 2005-2009: Sang Geun Bae, Jong Yeon Kim, Keon Yeop Kim, Soon Woo Park, Jisuk Bae, Won Kee Lee; J Prev Med Public Health. 2012;45(1):47-59. Published online January 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.1.47

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Abstract PDF

Objectives

This study was conducted to observe recent changes in adolescents' dietary behavior and indirectly evaluate the effects of the government's nutritional policies in Korea.

Methods

We analyzed the secular trends in seven dietary behaviors using the Korea Youth Risk Behavior Web-based Survey data from 2005 to 2009. Through literature review, we included the policies implemented for the improvement of adolescents'dietary behaviors during the same periods.

Results

The significant linear trends were observed in all dietary behaviors (p<0.05). Overall, all behaviors except the fruit intake rate were desirably changed during five years but undesirable changes were observed between 2008 and 2009 in all behaviors. Within those periods, several policies were implemented including 'Ban on carbonated-beverages in school', 'Green Food Zone', etc. Despite confirmed evidence of their effects, the policies on individual behavior such as nutrition education didn't influence the prevalence of dietary behaviors because they were conducted to too limited persons. Polices on the school environmental improvement, such as ban on carbonated beverage in school, were more effective because they decreased the exposure of undesirable food environment. However, for effect of Green Food Zone improving community environment we couldn't come to a conclusion because of too short period after full implementation.

Conclusions

Among government nutrition policies conducted from 2005 to 2009, those on environmental improvement, especially in school, were more effective than those on individual behavior. Therefore, the development and implement of policies on school environmental improvement are needed in Korea.

Summary

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English Abstracts

Epidemiological Investigation for Outbreak of Food Poisoning Caused by Bacillus cereus Among the Workers at a Local Company in 2010.: Kum Bal Choi, Hyun Sul Lim, Kwan Lee, Gyoung Yim Ha, Kwang Hyun Jung, Chang Kyu Sohn; J Prev Med Public Health. 2011;44(2):65-73.; DOI: https://doi.org/10.3961/jpmph.2011.44.2.65

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OBJECTIVES
In July 2 2010, a diarrhea outbreak occurred among the workers in a company in Gyeungju city, Korea. An epidemiological investigation was performed to clarify the cause and transmission route of the outbreak. METHODS: We conducted a questionnaire survey among 193 persons, and we examined 21 rectal swabs and 6 environmental specimens. We also delegated the Daegu Bukgu public health center to examine 3 food service employees and 5 environmental specimens from the P buffet which served a buffet on June 30. The patient case was defined as a worker of L Corporation and who participated in the company meal service and who had diarrhea more than one time. We also collected the underground water filter of the company on July 23. RESULTS: The attack rate of diarrhea among the employees was 20.3%. The epidemic curve showed that a single exposure peaked on July 1. The relative risk of attendance and non-attendance by date was highest for the lunch of June 30 (35.62; 95% CI, 2.25 to 574.79). There was no specific food that was statistically regarded as the source of the outbreak. Bacillus cereus was cultured from two of the rectal swabs, two of the preserved foods and the underground water filter. We thought the exposure date was lunch of June 30 according the latency period of B. cereus. CONCLUSIONS: We concluded the route of transmission was infection of dishes, spoons and chopsticks in the lunch buffet of June 30 by the underground water. At the lunch buffet, 50 dishes, 40 spoons, and chopsticks were served as cleaned and wiped with a dishcloth. We thought the underground water contaminated the dishes, spoons, chopsticks and the dishcloth. Those contaminated materials became the cause of this outbreak.

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Socioeconomic Costs of Food-Borne Disease Using the Cost-of-Illness Model: Applying the QALY Method.: Hosung Shin, Suehyung Lee, Jong Soo Kim, Jinsuk Kim, Kyu Hong Han; J Prev Med Public Health. 2010;43(4):352-361.; DOI: https://doi.org/10.3961/jpmph.2010.43.4.352

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OBJECTIVES
This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. METHODS: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. RESULTS: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 - 76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. CONCLUSIONS: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.

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The Concept and Measurement of Food Security.: Kirang Kim, Mi Kyung Kim, Young Jeon Shin; J Prev Med Public Health. 2008;41(6):387-396.; DOI: https://doi.org/10.3961/jpmph.2008.41.6.387

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Abstract PDF

OBJECTIVES
During the past two decades, food deprivation and hunger have been recognized to be not just the concerns of only underdeveloped or developing countries, but as problems for many affluent Western nations as well. Many countries have made numerous efforts to define and measure the extent of these problems. Based on these efforts, the theory and practice of food security studies has significantly evolved during the last decades. Thus, this study aims to provide a comprehensive review of the concept and measurement of food security. METHODS AND RESULTS: In this review, we introduce the definition and background of food security, we describe the impact of food insecurity on nutrition and health, we provide its measurements and operational instruments and we discuss its applications and implications. Some practical information for the use of the food security index in South Korea is also presented. CONCLUSIONS: Food security is an essential element in achieving a good nutritional and health status and it has an influence to reduce poverty. The information about the current understanding of food security can help scientists, policy makers and program practitioners conduct research and maintain outreach programs that address the issues of poverty and the promotion of food security.

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Original Articles

Epidemiologic Investigation of an Outbreak of Shigella sonnei among Students in Bonghwa, 1999.: Hyun Sul Lim, Geun Ryang Bae; Korean J Prev Med. 2000;33(1):10-16.

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Abstract PDF: OBJECTIVES
This study was carried out to investigate the sources of infection and modes of transmission of an outbreak of shigellosis that occurred among students of B middle and high school in Bonghwa, Korea from May 1 to 21, 1999. METHODS: We conducted questionnaires to 468 students, 38 staffs and 9 food handlers twice times (May 6, May 21) for follow up and secondary attack rate. Personal details and history of illness and exposure to particular foods were sought. And we conducted rectal swab for culture to 243 students, 33 staffs and 9 food handlers. Bacteriological examinations of water in the school were done. Cases were identified as subjects who had diarrhea (two or more loose stools in a 24-hour periods) on or after May 1. RESULTS: A total of 307 cases (attack rate: 59.6%) of 515 subjects were identified, including 50 confirmed (46 students and 4 staffs) by S. sonnei. All 9 food handlers denied illness and were had rectal swab for culture at May 6 that were negative for S. sonnei. 146 of 307 reported fever, 156 had tenesmus, 44 reported vomiting, and only 5 of 307 reported blood in the stool. The median duration of diarrhea was 4 days (range: 1-18 days). The mean incubation period until onset of diarrhea was 63 hours (range: 16-144 hours) and the secondary attack rate was 2.8% (43 cases of 1,561 family members). Risk for illness was higher among students who had eaten watered kimchi at March 30 than among those who did not [301(72.7%) of 417 versus 5(9.6%) of 52; RR=7.51; 95% CI=3.26-17.31]. CONCLUSION: The source of infection was estimated to be contaminated watered kimchi by one or two food handler who is presumed to be carrier.; Summary

Association of Liver Dysfunction with Self-Medication History in Korean Healthy Male Adults.: Jong Myon Bae, Byung Joo Park, Moo Song Lee, Dong Hyun Kim, Myung Hee Shin, Yoon Ok Ahn; Korean J Prev Med. 1996;29(4):801-814.

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Abstract PDF: BACKGROUND
Korean people could abuse healthy foods as well as medications, which might cause serious side effects. The aim of this study was elucidating liver dysfunction due to the self-medications of hepatotonics, healthy foods and herb medications by nested case-control study. METHODS: Study subjects were drawn from male members of seoul Cohort Study who were recruited by self-administered structured questionnaire survey through mailing to the healthy men between the age of 40 and 59 years through the program of biennial health check-up offered by Korea Medical Insurance Corporation(KMIC). The liver dysfunction was defined as the level of serum AST and ALT above 40 IU/L and increased in more than one hundred per-cent during the 2 year follow-up period. To estimate the odds ratio between self-medication and liver dysfunction after controlling for potential confounders, logistic regression was performed. RESULTS: During the follow-up period, 30 members were identified to fit into case criteria and 2,625 members were selected as control. In logistic regression analyses, history of healthy foods intake, age under 45 years, obesity, and habit of regular exercise were significantly associated with liver dysfunction. The following factors exhibited no statistical significance: intake of hepatotonics, of herb medicine; history of disease in family, of operation, and of radiologic examination; smoking habits and drinking amounts. CONCLUSION: The significant association between the intake of healthy foods and the liver dysfunction illustrates that chronically optional overuse of healthy foods might bring to hazards to health. As the increasing trend of the size of purchasing healthy foods in Korea, pharmacoepidemiologic studies evaluating the safety and efficacy of the widely used healthy foods should be performed in the near future.; Summary

English Abstracts

Human Multi-route Exposure Assessment of Lead and Cadmium for Korean Volunteers.: Eunha Oh, Eun Il Lee, Hosub Lim, Jae Yeon Jang; J Prev Med Public Health. 2006;39(1):53-58.

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Abstract PDF: OBJECTIVES
We wanted to evaluate the main route of exposure to lead and cadmium for the general population in Korea by using multi-route and multi-media exposure assessment METHODS: Samples of air at the homes, samples of the food and water and peripheral blood samples were collected from thirty volunteers living in Seoul (the metropolitan area), Yong-in (the suburban area) and Ansan (the industrial area) in 2001. Graphite furnace atomic absorption spectrometric methods were used for the determination of the Pb and Cd levels in the air, food, water and blood samples. RESULTS: The average intake of lead through the air, drinking water and food were 5.06 microgram/day (26.3%), 0.002 microgram/day (0.1%), and 16.4 microgram/day (73.6%), respectively. The average intake of cadmium through the air, drinking water and food were 0.082 microgram/day (0.9%), 0.001 microgram/day (0.007%), and 12.61 microgram/day (99.0%), respectively. The blood lead level was statistically higher in the male subjects than in the female subjects (3.39 and 2.22 microgram/dl, respectively), and only gender was a significant variable on the multiple regression analysis for blood lead. CONCLUSIONS: This study showed that the intake of lead and cadmium through food was the major route of exposure. A policy to reduce the pollutants according to the exposure routes should be established. However, more studies will be needed to support these data for the general population.; Summary

Epidemiologic Investigation on an Outbreak of Salmonellosis in Yeongcheon-si, 2004.: Hyun Sul Lim, Young Sun Min, Hwan Seok Lee; J Prev Med Public Health. 2005;38(4):457-464.

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Abstract PDF: OBJECTIVES
An outbreak of salmonellosis occurred among the students and staff of D primary school in Yeongcheon-si, 2004. This investigation was carried out to prevent any recurrence of this outbreak and to study the infection source and transmission of the salmonellosis. METHODS: The authors conducted a questionnaire survey among 1, 205 students and staff members from D primary school about the ingestion of the school lunch and drinking water, and the manifestation of their symptoms. The author examined rectal swabs, the tap water and microorganism cultures, and we also investigated the dining facility and water supply facility. RESULTS: The diarrheal cases were defined as the confirmed cases or the persons who had diarrhea more than one time with symptoms such as fever, vomiting and tenesmus. The diarrheal attack rate was 28.0%. Ingestion of fried bean curd with egg had a significantly high association with the diarrheal attack rate (p< 0.05), and the relative risk of the fried bean curd with egg was 10.68 (95% CI=3.88-29.41), as was determined by logistic regression analysis. The bacterial counts in the tap water of the food preparation room and toilet (first floor) exceeded the maximum permissible counts. S. Enteritidis bacteria were only cultured from the fried bean curd with egg of all the supplied foods on September 3, 2004. CONCLUSIONS: The major cause of salmonellosis was presumed to be the contaminated bean curd via contaminated tap water due to a water leak of a school water pipe. This contaminated bean curd was under prepared, which allowed the S. Enteritidis to survive and multiply prior to its ingestion.; Summary

Epidemiologic Investigation on an Outbreak of Shigellosis in Seongju-gun, Korea, 2003.: Young Sun Min, Hyun Sul Lim, Kwan Lee, Sang Hyuk Lim, Bog Soon Lee; J Prev Med Public Health. 2005;38(2):189-196.

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Abstract PDF: OBJECTIVES
An outbreak of shigellosis occurred among students and staff of S primary and middle school, Seongju-gun, in 2003. This investigation was carried out to institute an effective counterplan, and study the infection source and transmission of the shigellosis. METHODS: The authors conducted a questionnaire survey among 235 students and staff from S preschool, primary and middle school relating to the ingestion of school lunch and the manifestation of symptoms. Also, the author investigated the drinking water, feeding facility and reconstructed cooking process of the food presumed to be the cause of the shigellosis. The diarrhea cases were defined as confirmed cases and those cases who had had diarrhea more than one time, accompanied with symptoms such as fever, vomiting and tenesmus. RESULTS: From rectal swabs 20 people, between June 28 and July 4, 2003, were confirmed with shigellosis. The diarrhea attack rate was 40.0%. Those who had ingested tomatoes and cubed radish kimchi had significantly higher diarrhea attack rates (p< 0.05), with the relative risk of tomatoes being 2.69 (95% CI: 0.98-7.42). The major cause of shigellosis was presumed to be from contaminated tomatoes due to cooking with rubber gloves containing holes. CONCLUSION: The cooks in charge of school lunches must make doubly sure to not only attend to their sanitation, but also to manage the table wear and items used in providing school lunches. The health care authority should introduce higher-leveled criteria for health care among cooks, so that they cannot cook when the have a case of any infectious disease.; Summary

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