Public Health Exam (epi final)

Milk definition

"the lacteal secretion, practically free from colostrum, obtained from the complete milking of one or more healthy cows. Milk that is in its final package form for beverage use shall have been pasteurized or ultrapasteurized, and shall contain not less than 8.25% solids and not less than 3.25% milk fat." -Milk, as defined by the U.S. Code of Federal Regulations (CFR), 21 CFR 131.110

2. Describe product

A full description of the product should be drawn up, including relevant safety information such as: composition, physical/chemical structure, microcidal/static treatments, packaging,durability and storage conditions and method of distribution.

Millennium Goals 2

The commitment to achieve the goals comes from the highest political levels, for the first time, entire governments are committed to their achievement—including the trade and finance ministers who hold the world's purse strings.

natural cheese

The term "natural cheese" is an industry term referring to cheese that is made directly from milk. Process cheese is made using natural cheese plus other ingredients that are cooked together to change the textural and/or melting properties and increase shelf life.

The HACCP system consists of the following seven principles:

PRINCIPLE 1 Conduct a hazard analysis. PRINCIPLE 2 Determine the Critical Control Points (CCPs). PRINCIPLE 3 Establish critical limit(s). PRINCIPLE 4 Establish a system to monitor control of the CCP. PRINCIPLE 5 Establish the corrective action to be taken when monitoring indicates that a particular CCP is not under control. PRINCIPLE 6 Establish procedures for verification to confirm that the HACCP system is working effectively. PRINCIPLE 7 Establish documentation concerning all procedures and records appropriate to these principles and their application.

Preliminary Incubation Count (PI count)

The PI count is an estimate of the number of pyschrotrophic, or cold-loving, bacteria in milk. The PI count is not a regulatory test, and results of this test are interpreted as a general reflection of milk production practices on the farm and used as a tool to identify inadequate on-farm sanitation practices and holding temperature of milk in the bulk tank. The PI count is conducted by holding milk at 55°F for 18 hours. Bacteria that grow under refrigerated conditions are enumerated using the SPC method described above.

Standard Plate Count (SPC)

The SPC is an estimate of the total number of viable aerobic bacteria present in raw milk. This test is done by plating milk on a solid agar, incubating plates for 48 hours at 32 °C (90 °F), followed by counting bacteria that grow on plates.

Food Code

The U. S. Food and Drug Administration (FDA) publishes the Food Code, a model that assists food control jurisdictions at all levels of government by providing them with a scientifically sound technical and legal basis for regulating the retail and food service segment of the industry (restaurants and grocery stores and institutions such as nursing homes). Local, state, tribal, and federal regulators use the FDA Food Code as a model to develop or update their own food safety rules and to be consistent with national food regulatory policy.

Global Health

- Need to understand the link between water, sanitation and health from a global perspective - Should understand the environmental, social, economic and political factors playing a role in cholera

food handling

- Set your refrigerator at or below 40ºF and the freezer at 0ºF. Check both periodically with an appliance thermometer - Refrigerate or freeze meat, poultry, eggs, seafood and other perishables within 2 hours of cooking or purchasing. Refrigerate within 1 hour if the temperature outside is above 90ºF. - Never thaw food at room temperature, such as on the counter top. Food must be kept at a safe temperature during thawing. There are three safe ways to defrost food: in the refrigerator, in cold water, and in the microwave. Food thawed in cold water or in the microwave should be cooked immediately. - Always marinate food in the refrigerator. - Divide large amounts of leftovers into shallow containers for quicker cooling in the refrigerator.

1. Assemble HACCP team

- The appropriate product specific knowledge and expertise is necessary for the development of an effective HACCP plan. - Optimally, this is accomplished by assembling a multidisciplinary team. Where such expertise is not available on site, expert advice should be obtained from other sources. - The scope of the HACCP plan should be identified. The scope should describe which segment of the product chain is involved and the general classes of hazards to be addressed (e.g. does it cover all classes of hazards or only selected classes).

Milk solids vs total solids?

-Milk solids are the non-water components of milk - protein , lactose, and minerals. -Sometimes the combination of protein, lactose and minerals is called the solids not fat content, and when the fat is included it is called total solids content

soft swell

A can that is bulged on both ends, but not so tightly that the ends can't be pushed in somewhat with a thumb press.

hard swell

A can that is so tightly bulged on both ends that the ends can't be pressed in. A can with a hard swell will generally "buckle" before it bursts.

flipper

A can whose end normally looks flat, but "flips out" when struck sharply on one end.

leaker

A can with a crack or hole in the container that has caused leakage

#6 of the HACCP Process

6. List all potential hazards associated with each step, conduct a hazard analysis, and consider any measures to control identified hazards

springer

A can with one end bulged out. With sufficient pressure, this end will flip in, but the other end will flip out

Determinants of health Also

POLITICAL STABILITY CIVIL RIGHTS ENVIRONMENTAL DEGRADATION POPULATION GROWTH/PRESSURE URBANISATION DEVELOPMENT OF COUNTRY OF RESIDENCE

Good Manufacturing Protocols

- Current food good manufacturing practices (GMPs) are published in Title 21 of the Code of Federal Regulations, Part 110 (21 CFR 110). - GMPs describe the methods, equipment, facilities, and controls for producing processed food. - As the minimum sanitary and processing requirements for producing safe and wholesome food, they are an important part of regulatory control over the safety of the nation's food supply. - GMPs also serve as one basis for FDA inspections.

IHR Core Capacities

01. National legislation 02. National Focal Point communications and coordination 03. Surveillance 04. Response 05. Preparedness 06. Risk communications 07. Human resources 08. Laboratory 09. Points of entry 10. Food safety events 11. Chemical events 12. Nuclear events 13. Radiological events

acid cheeses

Acid cheeses are made by adding acid to the milk to cause the proteins to coagulate.

Acidophilus milk

Acidophilus milk contains Lactobacillus acidophilus, a probiotic lactic acid bacterium that is beneficial to human health. The Lactobacillus acidophilus bacteria use lactose for an energy source and reduce the amount of lactose present in milk.

Animals, Disease and the Environment

Animal/Human/Environment interface What impacts this interface? What can be done to limit impact? Climate change - temperature change Pollution Invasive species

Milk Bugs - EEK!

Bacillus cereus Brucella Campylobacter jejuni Coxiella burnetii E. coli O157:H7 Listeria monocytogenes Mycobacterium avium subspecies paratuberculosis Mycobacterium tuberculosis Salmonella Staphylococcus aureus Yersinia enterocolitica

General Ice Cream Processing Steps

Blend Ingredients Pasteurize Mix Homogenize Age Mix Add Liquid Flavors and Colors Freeze Add Fruits, Nuts, and Bulky Flavorings Package Harden

Neglected Tropical Diseases

Buruli Ulcer Chagas disease(American trypanosomiasis) Cysticercosis Dengue/Severe dengue Dracunculiasis (guinea-worm disease) Echinococcosis Fascioliasis Human African trypanosomiasis Leishmaniasis Leprosy Lymphatic filariasis Onchocerciasis Rabies Schistosomiasis Soil transmitted helminthiasis Trachoma Yaws Other 'neglected' conditions: Podoconiosis Snakebite Strongyloidiasis

cheese

Cheese can be made using pasteurized or raw milk. Cheese made from raw milk imparts different flavors and texture characteristics to the finished cheese. For some cheese varieties, raw milk is given a mild heat treatment (below pasteurization) prior to cheese making to destroy some of the spoilage organisms and provide better conditions for the cheese cultures. Cheese made from raw milk must be aged for at least 60 days

Measuring Health Status

DALY-Diasbility Adjusted Life Years DALE-Disability Adjusted Life Expectancy YLD- Years Living with Disability YLL-Years of Life Lost YHLL-Healthy Days of Life Lost QALY-Quality Adjusted Life Year DFLE-Disability Free Life Expectancy HeaLY-Healthy Life Years Life Expectancy Mortality Rates

butter

Cream churned into a solid state. In the U.S. butter must contain at least 80% milk fat, and the USDA grades its quality on flavor, body, texture, color and salt (AA, A, B, and C). Sweet butter is simply made with sweet, as opposed to sour cream -- almost all. All butter is salted unless it specifically says unsalted, in which case it has absolutely no salt

8. Establish critical limits for each CCP

Critical limits must be specified and validated if possible for each Critical Control Point. In some cases more than one critical limit will be elaborated at a particular step. Criteria often used include measurements of temperature, time, moisture level, and -

culture and health

Culture: The predominating attitudes and behaviour that characterise the functioning of a group or organisation Traditional health systems Beliefs about health Influence of culture of health

Influence of culture of health

Diversity, marginalisation and vulnerability due to race, gender and ethnicity

Vitamin Fortification

Fluid milk is often fortified with vitamin A and vitamin D. The package label must declare when milk is fortified. Whole milk is considered a good source of vitamin A. Vitamin A is a fat soluble vitamin that is found in the fat phase of milk. The vitamin A content that occurs naturally in 2%, 1% and skim milk is less than in whole milk because of the lower fat levels

Ice cream

Ice cream is a frozen blend of a sweetened cream mixture and air, with added flavorings. A wide variety of ingredients are allowed in ice cream, but the minimum amounts of milk fat, milk solids (protein + lactose + minerals), and air are defined by Standards of Identity in the U.S. Code of Federal Regulations (CFR)

12. Establish Documentation and Record Keeping

Efficient and accurate record keeping is essential to the application of a HACCP system. HACCP procedures should be documented. Documentation and record keeping should be appropriate to the nature and size of the operation. Documentation examples are: - Hazard analysis; - Critical limit determination. - CCP determination; Record examples are: - CCP monitoring activities; - Deviations and associated corrective actions; - Modifications to the HACCP system

8 MDGs

End Hunger Universal Education Gender Equality Child Health Maternal Health Combat HIV/AIDS Environmental Sustainability Global Partnership

11. Establish verification procedures

Establish procedures for verification. Verification and auditing methods, procedures and tests, including random sampling and analysis, can be used to determine if the HACCP system is working correctly. The frequency of verification should be sufficient to confirm that the HACCP system is working effectively. Examples of verification activities include: Review of the HACCP system and its records; Review of deviations and product dispositions; Confirmation that CCPs are kept under control. Where possible, validation activities should include actions to confirm the efficacy of all elements of the HACCP plan.

How they all come together

FDA mandates GMPs but not SOPs. USDA mandated Sanitation Standard Operating Procedures (SSOPs) for Meat and Poultry Operations effective January 27, 1997. The rule calls on plant management to develop SSOPs that address daily routine sanitary procedures, before and during operations to prevent direct product contamination or adulteration. Procedures should be specific for each plant and can be as detailed as the plant wants to make them.

HEALTH PATTERNS IN RESOURCE POOR COUNTRIES

INFECTIOUS/COMMUNICABLE DISEASES PREVALENT: VACCINE PREVENTABLE DISEASES, e.g. measles ACUTE RESPIRATORY INFECTIONS (ARI) DIARRHOEAL DISEASES (cholera) MALARIA TB HEPATITIS HIV/AIDS Plus: MALNUTRITION RELATED CONDITIONS: - CALORIE DEFICIENCIES - MICRO-NUTRIENT DEFICIENCIES TRAUMA/ACCIDENTS Many of these diseases are treatable

Ice cream contents

Ice cream must contain at least 10% milk fat, and at least 20% total milk solids, and may contain safe and suitable sweeteners, emulsifiers and stabilizers, and flavoring materials Ice cream may also be labeled as reduced fat (25% less fat than the reference ice cream), light (50% less fat than the reference), lowfat (less than 3 g fat/serving), or nonfat (less than 0.5 g fat/serving).

fresh cheeses

Fresh cheeses, such as cream cheese or queso fresco, are made by direct acidification.

Determinants of Health

Genetic make up Age Gender Lifestyle choices Community influences Income status Geographical location Culture Environmental factors Work conditions Education Access to health services

Emerging and Re-emerging Dz

Group I—Pathogens Newly Recognized in the Past Two Decades Acanthamebiasis Australian bat lyssavirus Babesia, atypical Bartonella henselae Ehrlichiosis Encephalitozoon cuniculi Encephalitozoon hellem Enterocytozoon bieneusi Helicobacter pylori Hendra or equine morbilli virus Hepatitis C Hepatitis E Human herpesvirus 8 Human herpesvirus 6 Lyme borreliosis Parvovirus B19 Group II—Re-emerging Pathogens Enterovirus 71 Clostridium difficile Mumps virus Streptococcus, Group A Staphylococcus aureus

HACCP

HACCP is a management system in which food safety is addressed through the analysis and control of biological, chemical, and physical hazards from raw material production, procurement and handling, to manufacturing, distribution and consumption of the finished product

What is global health?

Health problems, issues, and concerns that transcend national boundaries, which may be influenced by circumstances or experiences in other countries, and which are best addressed by cooperative actions and solutions (Institute Of Medicine, USA- 1997)

Millennium Goals 7

Hunger remains a global challenge, and ensuring that all children are able to complete primary education remains a fundamental, but unfulfilled, target that has an impact on all the other Goals. Lack of safe sanitation is hampering progress in health and nutrition, biodiversity loss continues apace, and greenhouse gas emissions continue to pose a major threat to people and ecosystems.

Millennium Goals 6

In our world today around 2.5 billion people do not have access to improved sanitation and some 1.2 billion people do not have access to an improved source of water. Projections indicate that in 2015 more than 600 million people worldwide will still be using unimproved water sources, almost one billion will be living on an income of less than $1.25 per day, mothers will continue to die needlessly in childbirth, and children will suffer and die from preventable diseases.

ISO 9000

International Organization for Standardization ISO is the world's largest developer of voluntary International Standards Quality management Deals with the requirements that organizations wishing to meet the standard have to fulfill Certified by 3rd party *Can expect a certain standard of that product - a certainty. (3rd party thing - not necessary, but retailers and producers like them) The ISO 9000 family addresses various aspects of quality management and contains some of ISO's best known standards. The standards provide guidance and tools for companies and organizations who want to ensure that their products and services consistently meet customer's requirements, and that quality is consistently improved.

Millennium Goals 4

Might not need more than about $50 billion of additional aid per year to meet the Goals. About $900 billion was invested in arms by governments in 2003 alone; and rich countries grant large support to their domestic agricultural producers, totaling $300 billion each year

Global Health - Refers to any health issue that concerns many countries or is affected by transnational determinants

Refers to any health issue that concerns many countries or is affected by transnational determinants such as: Climate change Urbanization Malnutrition - under or over nutrition

9. Establish a monitoring system for each CCP

Monitoring is the scheduled measurement or observation of a CCP relative to its critical limits. The monitoring procedures must be able to detect loss of control at the CCP. Further, monitoring should ideally provide this information in time to make adjustments to ensure control of the process to prevent violating the critical limits. Data derived from monitoring must be evaluated by a designated person with knowledge and authority to carry out corrective actions when indicated. If monitoring is not continuous, then the amount or frequency of monitoring must be sufficient to guarantee the CCP is in control. Most monitoring procedures for CCPs will need to be done rapidly because they relate to on-line processes and there will not be time for lengthy analytical testing. Physical and chemical measurements are often preferred to microbiological testing because they may be done rapidly and can often indicate the microbiological control of the product. All records and documents associated with monitoring CCPs must be signed by the person(s) doing the monitoring and by a responsible reviewing official(s) of the company.

HEALTH PATTERNS IN RESOURCE RICH COUNTRIES

NON-COMMUNICABLE DISEASES PREVALENT: Causes of death (all ages): 40% Circulatory diseases, e.g. heart disease, strokes, etc. 25% Cancers 16% Respiratory diseases 5% Injuries and Poisonings 0.6% Infectious diseases Premature mortality (<65): 25% Circulatory diseases 33% Cancers 16% Injuries (RTAs/Suicides) and Poisonings 1% Infectious diseases Many of these deaths are related to lifestyle factors and are preventable

Millennium Goals 5

One third of deaths - some 18 million people a year or 50,000 per day - are due to poverty-related causes. That's 270 million people since 1990, the majority women and children, roughly equal to the population of the US. (Reality of Aid 2004) Every year more than 10 million children die of hunger and preventable diseases - that's over 30,000 per day and one every 3 seconds. (80 Million Lives, 2003 / Bread for the World / UNICEF / World Health Organization)

pasteurization

Pasteurization is the process of heating a liquid to below the boiling point to destroy microorganisms. It was developed by Louis Pasteur in 1864 to improve the keeping qualities of wine. Commercial pasteurization of milk began in the late 1800s in Europe and in the early 1900s in the United States. In 1924 the U.S. Public Health Service developed the Standard Milk Ordinance to assist states with voluntary pasteurization programs, now called The Grade A Pasteurized Milk Ordinance (PMO),

PMO ?

Pasteurized Milk Ordinance

The global burden of disease

Predicted changes in burden of disease from communicable to non-communicable between 2004 and 2030 - Reductions in malaria, diarrhoeal diseases, TB and HIV/AIDS - Increase in cardiovascular deaths, COPD, road traffic accidents and diabetes mellitus Ageing populations in middle and low income countries Socioeconomic growth with increased car ownership Based on a 'business as usual' assumption

SOP

SOPs represent a different set of jobs to be performed that may or may not be related to the safety of a food product, while GMPs refer to a set of procedures and measures taken by a plant to ensure that the food is not adulterated: i.e." manufactured under such conditions that it is unfit for food" *should never see a product with no english (in the USA)

SPC used for..

SPC is used to monitor progress since consistent application of proper milking system cleaning practices, proper milking practices, udder hygiene and good mastitis prevention and control practices should allow dairy producers to produce milk with a low SPC, which is less than 5,000 colony forming units (cfu)of bacteria per milliliter. Federal regulations defined in the Pasteurized Milk Ordinance mandate that the milk SPC should not exceed 100,000 cfu/mL

poor sanitation

more intestinal infections

malnutrition

more susceptible to disease and less likely to recover

look at slide 29, 34

of powerpoint 22 (food safety)

Set type yogurt

Set type yogurt is when the yogurt is packaged with the fruit on the bottom of the cup and the yogurt on top.

Standard Operating Procedures

Standard Operating Procedures (SOPs) are descriptions of particular tasks undertaken in a food processing operation. A specific SOP should address the following: The purpose and frequency of doing a task, Who will do the task, a description of the procedure to be performed that includes all the steps involved, And the corrective actions to be taken if the task is performed incorrectly

Swiss style yogurt

Swiss style yogurt is when the fruit is blended into the yogurt prior to packaging.

Coliform Count (CC)

The CC is a test that estimates the number of bacteria that originate from manure or a contaminated environment. Milk samples are plated on Violet Red Bile agar or MacConkey's agar and incubated for 48 hours at 32°C (90°F), after which typical coliform colonies are counted. Coliform counts reflect hygiene and sanitation practices followed on the farm. Coliforms enter the milk supply as a consequence of milking dirty cows or dropping the milking claw into manure during milking. Coliform counts >100 cfu/mL suggest poor milking practices, dirty equipment, contaminated water, dirty milking facilities, and/or cows with subclinical or clinical coliform mastitis.

5. on-site confirmation of flow diagram

The HACCP team should confirm the processing operation against the flow diagram during all stages and hours of operation and amend the flow diagram where appropriate

International Health Regulations 2

The IHR, which entered into force on 15 June 2007, require countries to report certain disease outbreaks and public health events to WHO. The IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security

International Health Regulations

The International Health Regulations (IHR) are an international legal instrument that is binding on 194 countries across the globe, including all the Member States of WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide The IHR apply to public health emergencies such as infectious disease outbreaks, chemical spills, leaks and dumping, or nuclear melt-downs. The IHR aim to limit interference with international traffic and trade while ensuring public health through the prevention of disease spread.

Laboratory Pasteurization Count (LPC)

The LPC, also known as the thermoduric count, is an estimate of the number of bacteria that can survive laboratory pasteurization at 62.8°C (143°F) for 30 minutes. This process destroys most of the mastitis causing pathogens, selecting for those bacteria that can survive pasteurization temperatures (thermoduric bacteria). A high LPC is most often seen with persistent cleaning problems; faulty milking machine or worn out parts such as leaky pumps, old pipe line gaskets, inflations and other rubber parts; and milkstone deposits. This is not a regulatory test required by state or federal agencies

Key Concepts in Relation to Global Health

The determinants of health The measurement of health status The importance of culture to health The global burden of disease The key risk factors for various health problems The organisation and function of health systems

4. construct flow diagram

The flow diagram should be constructed by the HACCP team. The flow diagram should cover all steps in the operation. When applying HACCP to a given operation, consideration should be given to steps preceding and following the specified operation.

3. Identify intended use

The intended use should be based on the expected uses of the product by the end user or consumer. In specific cases, vulnerable groups of the population, e.g. institutional feeding, may have to be considered.

Millennium Goals 3

The major international financial institutions—the World Bank, the IMF, the regional development banks, and increasingly, the membership of the World Trade Organization—have made explicit that they will be accountable for achieving the Goals too.

Vat Pasteurization

The milk is pumped into the vat, the milk is heated to the appropriate temperature and held at that temperature for the appropriate time and then cooled. The cooled milk is then pumped out of the vat to the rest of the processing line, for example to the bottling station or cheese vat. Batch pasteurization is still used in some smaller processing plants.

Continuous Pasteurization

The most common process used for fluid milk is the continuous process. The milk is pumped from the raw milk silo to a holding tank that feeds into the continuous pasteurization system. The milk continuously flows from the tank through a series of thin plates that heat up the milk to the appropriate temperature. The milk flow system is set up to make sure that the milk stays at the pasteurization temperature for the appropriate time before it flows through the cooling area of the pasteurizer. The cooled milk then flows to the rest of the processing line, for example to the bottling station

Somatic Cell Count

The number of somatic cells in milk, referred to as the somatic cell count or SCC, is used throughout the world as an indicator of milk quality. The current regulatory limit for somatic cells in milk in the United States defined in the Grade "A" Pasteurized Milk Ordinance is 750,000 cells per milliliter (mL). A milk SCC of more than 200,000 per mL suggests that an inflammatory response has been elicited, a mammary quarter is infected or is recovering from an infection, and that milk has reduced manufacturing properties

Successes???

The proportion of people living on less than $1.25 a day fell from 47 per cent in 1990 to 24 per cent in 2008—a reduction from over 2 billion to less than 1.4 billion. The proportion of people using an improved water source rising from 76 per cent in 1990 to 89 per cent in 2010. The 2010 target of universal access to treatment for HIV/AIDS improved, however, was not reached.

Homogenization

The purpose of homogenization is to reduce the milk fat globules size to less than 1.0 µm which allows them to stay evenly distributed in milk. Homogenization is a high pressure process that forces milk at a high velocity through a small orifice to break up the globules. The result of homogenization is the creation of many more fat globules of a smaller size.

7. Determine Critical Control Points

There may be more than one CCP at which control is applied to address the same hazard.

Sanitation Standard Operating Procedures (SSOP)

These are written procedures that a plant develops and implements to prevent direct contamination or adulteration of a product. The establishment must maintain daily records to show these SSOPs are done and record any necessary corrective action.

Standardization

To achieve standardization, milk is processed through centrifugal separators to create a skim portion and a cream portion of the milk. The cream portion is then added back to the skim portion to yield the desired fat content for the product. Common products are whole milk (3.25% fat), 2% and 1% fat milk, and skim milk (< 0.1% fat).

The Purpose of Pasteurization

To increase milk safety for the consumer by destroying disease causing microorganisms (pathogens) that may be present in milk. To increase keeping the quality of milk products by destroying spoilage microorganisms and enzymes that contribute to the reduced quality and shelf life of milk. --- These conditions were determined to be the minimum processing conditions needed to kill Coxiella burnetii, the organism that causes Q fever in humans, which is the most heat resistant pathogen currently recognized in milk. The phosphatase test is applied to dairy products to determine whether pasteurization was done properly and also to detect the possible addition of raw milk to pasteurized milk.

Food

Top: ISO 9000 middle: HACCP bottom: GMPs, SOPs

Millennium Goals

When 189 Heads of State and government from the North and South, as representatives of their citizens, signed onto the Millennium Declaration at the 2000 UN Millennium Summit, there was a palpable sense of urgency. Urgency to "free our fellow men, women and children from the abject and dehumanizing conditions of extreme poverty, to which more than a billion of them are currently subjected."

yogurt

Yogurt is a fermented milk product that contains the characteristic bacterial cultures Lactobacillus bulgaricus and Streptococcus thermophilus. All yogurt must contain at least 8.25% solids not fat. Full fat yogurt must contain not less than 3.25% milk fat, lowfat yogurt not more than 2% milk fat, and nonfat yogurt less than 0.5% milk.

advertising tobacco and alcohol

addiction and related diseases

poor life circumstances

commercial sex work and STIs, HIV/AIDS

Beliefs about health

e.g. epilepsy - a disorder of neuronal depolarisation vs a form of possession/bad omen sent by the ancestors Psychoses - ancestral problems requiring the assistance of traditional healer/spiritualist

Bioterror pathogens

http://www.niaid.nih.gov/topics/BiodefenseRelated/Biodefense/Pages/CatA.aspx#

videos

http://www.youtube.com/watch?v=0JnIJypPL-Q&feature=player_embedded http://www.youtube.com/watch?v=sMFqYMqT-_Q&feature=player_embedded#t=14s http://www.youtube.com/watch?v=TY3p0SZhPFA&feature=related

Alkaline Phosphatase (ALP)

is an enzyme naturally present in all raw milks, which is used as an indicator of proper milk pasteurization. Complete pasteurization will inactivate the enzyme to below levels which are detectable by conventional methods. Because the heat stability of ALP is greater than that of pathogens which may be present in milk, the enzyme serves as an indicator of product safety. However, the failure to detect ALP activity does not guarantee that the product is pathogen free. The classic test for the determination of alkaline phosphatase activity is the Scharer Rapid Phosphatase Test.

cooking with wood and coal

lung disease

Multi-sectoral Dimension of the Determinants of Health

malnutrition cooking with wood and coal poor sanitation poor life circumstances advertising tobacco and alcohol rapid growth in vehicular traffic often with untrained drivers on unsafe roads

milk secreted into a cow's udder is ________

milk secreted into an uninfected cow's udder is sterile -Invariably it becomes contaminated during milking, cooling and storage, and milk is an excellent medium for bacteria, yeasts and moulds that are the common contaminants -Their rapid growth, particularly at high ambient temperatures can cause marked deterioration, spoiling the milk for liquid consumption or manufacture into dairy products. This can be avoided by adopting the simple, basic rules of clean milk production.

rapid growth in vehicular traffic often with untrained drivers on unsafe roads

road traffic accidents

Canned Foods

soft swell hard swell flipper springer leaker

Global Health - can refer to solutions

solutions such as: Polio eradication Containment of avian influenza Approaches to tobacco control

General Yogurt Processing Steps

•Adjust Milk Composition & Blend Ingredients •Pasteurize Milk •Homogenize •Cool Milk •Inoculate with Starter Cultures •Hold •Cool •Add Flavours & Fruit •Package

General Cheese Processing Steps

•Standardize Milk •Pasteurize/Heat Treat Milk •Cool Milk •Inoculate with Starter & Non-Starter Bacteria and Ripen •Add Rennet and Form Curd •Cut Curd and Heat •Drain Whey •Texture Curd •Dry Salt or Brine •Form Cheese into Blocks •Store and Age •Package