An Uninvited Guest: Food Poisoning and Foodborne outbreaks, who are the villains of the piece?

January 16, 2024 girlymicro Microbiology (Clinical) e-coli, food, food-safety, health, listeria, nutrition, outbreaks, salmonella

This month is the start of a painful re-entry into normal life. Normal life in terms of work demands, normal life in terms of commuting and normal life in terms of getting back to not eating party food and leftovers for at least 50% of our meals. Now, mummy Girlymicro, Mr Girlymicro, and I have done our fair share of celebrating over the last few weeks, including eating out at large catered events and throwing our own parties for friends. Clinically, norovirus is now giving us its cyclical peak, and there was also a lot of food related outbreak news over the holidays. I thought, therefore, that I would start this years IPC related posts with one on foodborne outbreaks and the kinds of organisms involved.

Food related sickness and outbreaks can be caused by a number of different microorganisms and through a few different routes. The two main routes are infection and intoxication, and these are related to the organisms that tend to be the causative agents. The foods that are linked to these routes are also different, and if investigating can give you an idea of what you might be looking for, especially when combined with presentation, both in terms of clinical symptoms and speed.

Infection vs intoxication

Intoxication based food poisoning is usually linked to rapid onset symptoms following the ingestion of the food i.e. a matter of hours. This is because the symptoms aren’t related to an infection based process, where symptoms are linked to the invasion and replication process of the organism. There are two main types of toxins, heat stable and heat labile toxins. Heat stable toxins can be problematic, as once present in food these cannot be removed purely by re-heating to an appropriate temperature. Heat stable toxins, such as those produced by Bacillus cereus, are produced when the bacteria are present, hitting the right temperatures then kills the bacteria but the toxins remain. This process can be exacerbated when foods are not rapidly chilled or are left at a temperature where the bacteria could grown, there is therefore a prolonged period when toxins could be produced. Toxin related food poisoning (intoxication) can be caused by both bacteria and fungi.

Infection based food poisoning is linked to the ingestion of the organism itself, and presentations are therefore usually delayed as the organism needs to infect the gut mucosa. Many organisms that produce toxins can also cause infection related symptoms if present in high enough loads, and if suitable temperatures for bacterial kill are not met. Infection based food poisoning can be due to viruses, such as norovirus, parasites, such as E. histolytica, as well as bacteria, and the risks are often related to food hygiene efficiency as well as production factors.

Patient management

Most food related illness self resolves and management is mainly focussed on maintaining hydration and electrolyte balance. There is usually a requirement to undertake a minimum isolation period of 48 hours post symptoms in order to prevent any ongoing risk of person to person transmission, even if the original acquisition is thought to be via a food related source. Isolation may need to be prolonged in relation to certain groups because of the risk of ongoing to spread to others, either through personal hygiene awareness or through work based activity.

Recommendations for the Public Health Management of Gastrointestinal Infections 2019: Principles and Practice has a lot more detail on the main organisms associated with foodborne illnesses and some of these requirements for isolation. I’ve attached a copy below, but the link is also here in case it’s useful.

management_of_gastrointestinal_infections Download

If symptoms continue for period of a week or are especially severe it may be necessary to take samples in order to identify a causative organism in order to support patient management. When taking a patient history it’s important to capture any patient specific risk factors (see below section on risk groups), travel history, recent event attendance history and details of hobbies (such as preserving) that may impact of food ingestion patterns. Additional individual management options can include antimicrobials (antiparasitic or antibacterial) and for non-bloody diarrhoea without fever antidiarrheal agents.

How do these organisms get into food?

Organisms can get into food from numerous sources. They can be present in the environment in which the food comes from, such as manure that is used to fertilise salad plants can contain organisms, like E. coli, even more so if human waste is used. Food, such as oysters, can be contaminated as part of their life cycle as filter feeders if they are growing in an environment where they are exposed to animal or human waste, and so can harbour organisms like norovirus and become highly loaded. Food can also become contaminated as part of the production or manufacturing process, contaminated from other items that are produced in the same facility, contaminated from the processes, such as the water or preservatives utilised, or from failures in the preservation process that would normally have removed organisms that are naturally present linked to food.

Organisms can also come from the humans involved in the process. Those manufacturing or handling the food may be carrying or infected with organisms, whether symptomatic or not. A Staphylococcus aureus colonised person making sandwiches may contaminated the food they are making. An asymptomatic norovirus infected canteen worker could expose those being served food by unwittingly contaminating food and/or serving implements. In the case of bacteria, low level contamination from those producing the food may then be able to grow up to levels where ingestion results in symptoms if the processes are not well enough controlled.

Food processing and manufacturing

Most food preserving techniques aim to ensure that if contamination occurs during production or manufacturing it is not able to replicate to the point where the organism would cause symptoms in those who ingest them. Many preserving techniques aim to control organism survival or replication/loading via either temperature, cell lysis/resource availability or both. There are two main groups of techniques, either physical or chemical.

Some of these processes are more prone to risk of failure than others, both depending on the process and where is it being undertaken. When undertaken in food manufacturing, these techniques are usually undertaken under highly controlled conditions using the HACCP process in order to manage some of this risk variance:

Food preparation in the home

Obviously, none of us are following HACCP processes when we are preparing food at home, that doesn’t mean that there isn’t any risk to home cooking. One of the hazards linked to cooking at home can be the home environment itself. I’m still aware of people who wash out chicken or turkey cavities in their kitchen sink, unaware of the droplets that are produced and how they can then deposit on other surfaces, which are now contaminated whilst appearing visibly clean. Other hazards can link to the fact that most of us don’t have access to rapid (blast) cooling, and therefore when cooking big batches of food and putting in the fridge, the cooling process may not be fast enough to prevent bacterial growth. Also, in terms of equipment, I work in IPC and I’m a bit of a control freak so I possess things like meat thermometers, in order to ensure that meat has reached appropriate safe temperatures. I am aware that not everyone lives in this particular world, and so may not have some of these pieces of kit lying around.

Most of the time if you end up preparing food less well at home the consequences are non-ideal but not massively serious, however, if you have an ‘at risk’ member of your household or visiting then it becomes more important to focus on controlling these risk, both through the food that is brought and how it is prepared.

Food preparation (catering)

We’ve already talked a little about the HACCP processes that are put in place to control risk in formal settings. Catering can be a tricky area of risk, even if undertaken by professionals. It is one thing to undertake catering in your restaurant or a space you work in all the time. Catering however, is often undertaken in sites that are not the ‘home’ of either the professional or the average person. Catering equipment can be hired to serve food in church halls, for weddings or other special events. It can also be undertaken on beaches, in forests and other remote locations with variable levels of power to support refrigeration. This can mean that control processes, such temperature control, are undertaken in atypical ways, such as temperature control using ice packs, which will have variable efficiency depending on external factors, such as ambient temperature.

Home catering for parties also brings risks. I love to throw an afternoon tea party for charity, but that means that I am suddenly trying to put waaaaaay more in the fridge than I normally would. Food may be out on a table for a number of hours. Some of the food may also be high risk, such as cheese or smoked fish, and it will be next to less high risk foods. Also, if you are not used to prepping food for large groups, you may inadvertently increase risks by the order in which food it prepped. That is without the risk of people bringing food to contribute to yours which you don’t know the origins of, or people picking up food with fingers and therefore increasing risk of spread if they have anything onboard.

Food storage

Once all of that catering is done, you are then left with a decision, what do you do with all the food that is left? Do you then try and shove it all in your fridge or freezer? Do you give it people to take home in Tupperware pots? How much have you taken into account the length of time that food has been non-temperature controlled? What does that do to the use by? Is everyone aware of any re-heating requirements or the dangers irrespective of re-heating of intoxication?

Issues with food storage are true not just for party catering, but also for batch cooking, something a lot of us are doing more and more of now the weather is colder and because food it more expensive. Foods like stews and rice dishes, which are high risk for intoxication, are also the kinds of foods that fulfil a lot of batch cooking requirements. It is really important to bear these risks in mind, ensuring rapid cooling and that temperature is monitored appropriately.

This also extends to ensuring that even dry goods are stored appropriately. We’ve all been there when we’ve found the pack of spice that 15 years old. Spices, canned goods and other preserved food have been identified as the source of outbreaks, and even when originally in good condition can become a risk if not well maintained, such as dented cans or if moisture has gotten into packets.

What kind of incidences are we talking about?

Over the Christmas period there have been two well publicised food related outbreaks, one linked to E. coli in cheese and one linked Cronobacter sakazakii (previously Enterobacter sakazakii) in infant formula.

BBC News – One dead after E. coli outbreak linked to cheese

This outbreak was linked to the presence of STEC toxin producing strain of E. coli. This leads to an intoxication that can impact of kidney function. Although not stated, elsewhere it was reported that the cheese may have been made from unpasteurised milk, removing one of the stages used to control organism risk in food production.

Advice for individuals from UKHSA included:

“Washing your hands with soap and warm water and using bleach-based products to clean surfaces will help stop infections from spreading. Don’t prepare food for others if you have symptoms or for 48 hours after symptoms stop.

“Do not return to work or school once term restarts until 48 hours after your symptoms have stopped.”
https://www.bbc.co.uk/news/health-67840758

The other recent recall was linked to possible contamination of infant formula detected at manufacturing. Formula feed outbreaks linked to Cronobacter sakazakii have been noted in the past, with a large outbreak in France being the last large scale event. Infection does not just lead to GI symptoms but is associated in some patients with presentations such as blood stream infection and/or meningitis.

The formula included in this recall is mostly used in healthcare or is prescribed to individuals. This makes it critical as it is likely to have been given to an ‘at risk’ population. Milk related contamination is particularly challenging as heating impacts the nutritional content of the milk and so use of thermal risk reduction is not straight forward. Some hospitals, such as the one where I work, undertake an additional step, pasteurisation, for any formula feeds due to be given to high risk infants because of this well acknowledged risk in order to support infection risk reduction.

BBC News – Baby formula recalled over bacteria contamination fears

Current and Future Perspectives on the Role of Probiotics, Prebiotics, and Synbiotics in Controlling Pathogenic Cronobacter Spp. in Infants
October 2021 Frontiers in Microbiology 12

There are obviously multiple examples every year of foodborne risks linked to contamination at source or HACCP failure, but these are the ones that have been most recently featured in the national press.

Are any groups at higher risk?

Although food related infection or intoxication can impact anyone, certain groups are more at risk of significant symptoms requiring treatment or are more at risk linked to certain organisms in terms of presentation. These groups are your very young, very old, the immunosuppressed and pregnant women. The very young and very old are more likely to need support linked to dehydration, and all 4 groups are likely to be less able to mount immune responses to invasive infection. The immunosuppressed and pregnant women have specific guidance linked to avoiding high-risk food groups because of severity of impact if infection occurs.

One particular organism linked with significant infection risk for pregnant women and the immunosuppressed is Listeria monocytogenes.

Listeria crosses the gut wall at locations known as Peyer’s patches, and from there invades lymph nodes and blood. Once in the bloodstream, it can progress to cause meningitis/encephalitis by infecting the brain. In pregnant women it can also cross over into the placenta, where it can cause infection in the foetus/unborn child. Foodborne listeria outbreaks have been associated with a wide variety of foods, but are often linked to preserved foods and cheese.

https://www.gov.uk/government/publications/listeria-monocytogenes-surveillance-reports/listeriosis-in-england-and-wales-summary-for-2021

How do we investigate foodborne outbreaks?

There are a number of stages to investigating foodborne outbreaks. Initially, there will need to be some sort of flag to suggest an outbreak event. This is usually a number of people attending GPs or A&E linked to a single event, an uptick in samples positive for a specific organisms that is noted through lab reporting, or any cases of specific reportable organisms which will then get followed up.

Depending on the circumstances, a combination of the following steps will be undertaken:

Patient questionnaire (case)
Questionnaire of those who attended the same event but did not get sick (control)
Sampling and microbiological testing of possible implicated food, if still available
Sampling of the production environment, such as factories or restaurant kitchens

Investigation needs to be undertaken to identify the target food or batch as most production facilities will make more than one kind of food and will have multiple batches. If the outbreak is linked to a specific event, multiple types of party or other food is likely to have been available. Getting more information about what those who got sick ate vs the others enables you to narrow down what the culprit might be.

Once you have your questionnaires, it’s time for a little bit of stats. This enables you to calculate something called the relative risk for the cohort. The cohort being all those people who were at the same event, ate at the same restaurant, brought food from the same factory etc. This will include those who became unwell and those who did not. For each type of food or batch you can calculate a ratio of the risk of disease (infection/intoxication) in people who have been exposed (ate that food) compared to those unexposed (decided that food was not for them).

You then get a list of risks for different food types eaten. So if the following food was available at our event you can then undertake the calculation:

pigs in blankets
mini fish and chips
turkey and stuffing roulade
mini pavlova (with cream)
cheese pinwheels

If the number if >1 then it indicates and increased risk, if RR = 1 then it doesn’t impact on risk, and if RR <1 then there is a risk reduction. So in the case of our party food:

pigs in blankets RR = 1
mini fish and chips = 0.98
turkey and stuffing roulade = 1.73
mini pavlova (with cream) = 1.1
cheese pinwheels = 0.99

In conclusion………the turkey probably did it!

I hope that’s helpful, I know there’s loads more that could be covered, and if you are interested in anything in particular drop me a comment and I’ll see if I can post a follow up. The main take away is that there are multiple organisms that can cause foodborne infection/intoxication, and whether it’s home or out and about we can all be impacted. For most of us, it’s an unpleasant but low consequence event, but there are are people and populations where the outcomes can be much more severe. So, if you’re ever asked to complete a questionnaire please do so, and don’t ignore those news articles that tell you to throw an item away as it’s not a risk worth taking.

All opinions in this blog are my own

It’s Beginning to Look a Lot Like Christmas: Why I love the BMJ Christmas articles and links to my favourites!

December 28, 2023 girlymicro General, Research/Academia, Science Communication blog, health, PhD, public engagement, Research, science, Science Communication, sleep, wellness

I adore Christmas, it’s one of my favourite times of the year. I meant to get this one out before Christmas, but to be honest, I was too busy having family time. For those of us working or looking for some fun reading between Christmas and New Year I thought this one might still be of interest.

Every year the British Medical Journal have a wonderful tradition. They post some free to access journal article. Now, these aren’t just any journal articles. They apply serious scientific processes to brilliant topics, such as the disappearance rates hard vs soft centred chocolates in ward environments presented as an observational study.

These articles always bring a smile to my face, and if you’re looking at an entertaining way to learn more about scientific processes or scientific writing these are a great place to start. I hope you’ll feel the same when you have a read of some of the ones linked to below, and know that there are more out there if you want to journey down this particular rabbit hole.

Merry Christmas, and thank you so much for spending another year in the company of the Girlymicro blog!

From 2005

The case of the disappearing teaspoons: longitudinal cohort study of the displacement of teaspoons in an Australian research institute BMJ 2005;331:1498

Abstract

Objectives To determine the overall rate of loss of workplace teaspoons and whether attrition and displacement are correlated with the relative value of the teaspoons or type of tearoom.
Design Longitudinal cohort study.
Setting Research institute employing about 140 people.
Subjects 70 discreetly numbered teaspoons placed in tearooms around the institute and observed weekly over five months.
Main outcome measures Incidence of teaspoon loss per 100 teaspoon years and teaspoon half life.

Results 56 (80%) of the 70 teaspoons disappeared during the study. The half life of the teaspoons was 81 days. The half life of teaspoons in communal tearooms (42 days) was significantly shorter than for those in rooms associated with particular research groups (77 days). The rate of loss was not influenced by the teaspoons’ value. The incidence of teaspoon loss over the period of observation was 360.62 per 100 teaspoon years. At this rate, an estimated 250 teaspoons would need to be purchased annually to maintain a practical institute-wide population of 70 teaspoons.

Conclusions The loss of workplace teaspoons was rapid, showing that their availability, and hence office culture in general, is constantly threatened.

the-case-of-the-disappearing-teaspoons-longitudinal-cohort-study-of-the-displacement-of-teaspoons-in-an-australian-research-institute Download

From 2010

Beauty sleep: experimental study on the perceived health and attractiveness of sleep deprived people BMJ 2010;341:c6614

Abstract

Objective To investigate whether sleep deprived people are perceived as less healthy, less attractive, and more tired than after a normal night’s sleep.
Design Experimental study.
Setting Sleep laboratory in Stockholm, Sweden.
Participants 23 healthy, sleep deprived adults (age 18-31) who were photographed and 65 untrained observers (age 18-61) who rated the photographs.
Intervention Participants were photographed after a normal night’s sleep (eight hours) and after sleep deprivation (31 hours of wakefulness after a night of reduced sleep). The photographs were presented in a randomised order and rated by untrained observers.
Main outcome measure Difference in observer ratings of perceived health, attractiveness, and tiredness between sleep deprived and well rested participants using a visual analogue scale (100 mm).

Results Sleep deprived people were rated as less healthy (visual analogue scale scores, mean 63 (SE 2) v 68 (SE 2), P<0.001), more tired (53 (SE 3) v 44 (SE 3), P<0.001), and less attractive (38 (SE 2) v 40 (SE 2), P<0.001) than after a normal night’s sleep. The decrease in rated health was associated with ratings of increased tiredness and decreased attractiveness.

Conclusion Our findings show that sleep deprived people appear less healthy, less attractive, and more tired compared with when they are well rested. This suggests that humans are sensitive to sleep related facial cues, with potential implications for social and clinical judgments and behaviour. Studies are warranted for understanding how these effects may affect clinical decision making and can add knowledge with direct implications in a medical context.

beauty-sleep-experimental-study-on-the-perceived-health-and-attractiveness-of-sleep-deprived-people Download

From 2013

The survival time of chocolates on hospital wards: covert observational study BMJ 2013;347:f7198

Abstract

Objective To quantify the consumption of chocolates in a hospital ward environment.
Design Multicentre, prospective, covert observational study.
Setting Four wards at three hospitals (where the authors worked) within the United Kingdom.
Participants Boxes of Quality Street (Nestlé) and Roses (Cadbury) on the ward and anyone eating these chocolates.
Intervention Observers covertly placed two 350 g boxes of Quality Street and Roses chocolates on each ward (eight boxes were used in the study containing a total of 258 individual chocolates). These boxes were kept under continuous covert surveillance, with the time recorded when each chocolate was eaten.
Main outcome measure Median survival time of a chocolate.

Results 191 out of 258 (74%) chocolates were observed being eaten. The mean total observation period was 254 minutes (95% confidence interval 179 to 329). The median survival time of a chocolate was 51 minutes (39 to 63). The model of chocolate consumption was non-linear, with an initial rapid rate of consumption that slowed with time. An exponential decay model best fitted these findings (model R²=0.844, P<0.001), with a survival half life (time taken for 50% of the chocolates to be eaten) of 99 minutes. The mean time taken to open a box of chocolates from first appearance on the ward was 12 minutes (95% confidence interval 0 to 24). Quality Street chocolates survived longer than Roses chocolates (hazard ratio for survival of Roses v Quality Street 0.70, 95% confidence interval 0.53 to 0.93, P=0.014). The highest percentages of chocolates were consumed by healthcare assistants (28%) and nurses (28%), followed by doctors (15%).

Conclusions From our observational study, chocolate survival in a hospital ward was relatively short, and was modelled well by an exponential decay model. Roses chocolates were preferentially consumed to Quality Street chocolates in a ward setting. Chocolates were consumed primarily by healthcare assistants and nurses, followed by doctors. Further practical studies are needed.

the-survival-time-of-chocolates-on-hospital-wards-covert-observational-study Download

From 2015

Evidence of a Christmas spirit network in the brain: functional MRI study BMJ 2015;351:h6266

Abstract

Objective To detect and localise the Christmas spirit in the human brain.
Design Single blinded, cross cultural group study with functional magnetic resonance imaging (fMRI).
Setting Functional imaging unit and department of clinical physiology, nuclear medicine and PET in Denmark.
Participants 10 healthy people from the Copenhagen area who routinely celebrate Christmas and 10 healthy people living in the same area who have no Christmas traditions.
Main outcome measures Brain activation unique to the group with Christmas traditions during visual stimulation with images with a Christmas theme.

Methods Functional brain scans optimised for detection of the blood oxygen level dependent (BOLD) response were performed while participants viewed a series of images with Christmas themes interleaved with neutral images having similar characteristics but containing nothing that symbolises Christmas. After scanning, participants answered a questionnaire about their Christmas traditions and the associations they have with Christmas. Brain activation maps from scanning were analysed for Christmas related activation in the “Christmas” and “non-Christmas” groups individually. Subsequently, differences between the two groups were calculated to determine Christmas specific brain activation.

Results Significant clusters of increased BOLD activation in the sensory motor cortex, the premotor and primary motor cortex, and the parietal lobule (inferior and superior) were found in scans of people who celebrate Christmas with positive associations compared with scans in a group having no Christmas traditions and neutral associations. These cerebral areas have been associated with spirituality, somatic senses, and recognition of facial emotion among many other functions.

Conclusions There is a “Christmas spirit network” in the human brain comprising several cortical areas. This network had a significantly higher activation in a people who celebrate Christmas with positive associations as opposed to a people who have no Christmas traditions and neutral associations. Further research is necessary to understand this and other potential holiday circuits in the brain. Although merry and intriguing, these findings should be interpreted with caution.

evidence-of-a-christmas-spirit-network-in-the-brain-functional-mri-study Download

From 2021

Ghost in the machine or monkey with a typewriter—generating titles for Christmas research articles in The BMJ using artificial intelligence: observational study BMJ 2021;375:e067732

Abstract

Objective To determine whether artificial intelligence (AI) can generate plausible and engaging titles for potential Christmas research articles in The BMJ.
Design Observational study.
Setting Europe, Australia, and Africa.
Participants 1 AI technology (Generative Pre-trained Transformer 3, GPT-3) and 25 humans.
Main outcome measures Plausibility, attractiveness, enjoyability, and educational value of titles for potential Christmas research articles in The BMJ generated by GPT-3 compared with historical controls.

Results AI generated titles were rated at least as enjoyable (159/250 responses (64%) v 346/500 responses (69%); odds ratio 0.9, 95% confidence interval 0.7 to 1.2) and attractive (176/250 (70%) v 342/500 (68%); 1.1, 0.8 to 1.4) as real control titles, although the real titles were rated as more plausible (182/250 (73%) v 238/500 (48%); 3.1, 2.3 to 4.1). The AI generated titles overall were rated as having less scientific or educational merit than the real controls (146/250 (58%) v 193/500 (39%); 2.0, 1.5 to 2.6); this difference, however, became non-significant when humans curated the AI output (146/250 (58%) v 123/250 (49%); 1.3, 1.0 to 1.8). Of the AI generated titles, the most plausible was “The association between belief in conspiracy theories and the willingness to receive vaccinations,” and the highest rated was “The effects of free gourmet coffee on emergency department waiting times: an observational study.”

Conclusions AI can generate plausible, entertaining, and scientifically interesting titles for potential Christmas research articles in The BMJ; as in other areas of medicine, performance was enhanced by human intervention.

ghost-in-the-machine-or-monkey-with-a-typewritere28094generating-titles-for-christmas-research-articles-in-the-bmj-using-artificial-intelligence-observational-study Download

From 2023

As a special Christmas gift there were 2 from 2023 that made me exceptionally happy!

Effect of a doctor working during the festive period on population health: natural experiment using 60 years of Doctor Who episodes (the TARDIS study) BMJ 2023;383:e077143

Abstract

Objective To examine the effect of a (fictional) doctor working during the festive period on population health.
Design Natural experiment.
Setting England, Wales, and the UK.

Main outcome measures Age standardised annual mortality rates in England, Wales, and the UK from 1963, when the BBC first broadcast Doctor Who, a fictional programme with a character called the Doctor who fights villains and intervenes to save others while travelling through space and time. Mortality rates were modelled in a time series analysis accounting for non-linear trends over time, and associations were estimated in relation to a new Doctor Who episode broadcast during the previous festive period, 24 December to 1 January. An interrupted time series analysis modelled the shift in mortality rates from 2005, when festive episodes of Doctor Who could be classed as a yearly Christmas intervention.

Results 31 festive periods from 1963 have featured a new Doctor Who episode, including 14 broadcast on Christmas Day. In time series analyses, an association was found between broadcasts during the festive period and subsequent lower annual mortality rates. In particular, episodes shown on Christmas Day were associated with 0.60 fewer deaths per 1000 person years (95% confidence interval 0.21 to 0.99; P=0.003) in England and Wales and 0.40 fewer deaths per 1000 person years (0.08 to 0.73; P=0.02) in the UK. The interrupted time series analysis showed a strong shift (reduction) in mortality rates from 2005 onwards in association with the Doctor Who Christmas intervention, with a mean 0.73 fewer deaths per 1000 person years (0.21 to 1.26; P=0.01) in England and Wales and a mean 0.62 fewer deaths per 1000 person years (0.16 to 1.09; P=0.01) in the UK.

Conclusions A new Doctor Who episode shown every festive period, especially on Christmas Day, was associated with reduced mortality rates in England, Wales, and the UK, suggesting that a doctor working over the festive period could lower mortality rates. This finding reinforces why healthcare provision should not be taken for granted and may prompt the BBC and Disney+ to televise new episodes of Doctor Who every festive period, ideally on Christmas Day.

bmj-2023-077143.full_Download

Analysis of Barbie medical and science career dolls: descriptive quantitative study BMJ 2023;383:e077276

Abstract

Objectives To identify Barbie brand dolls that had medicine and science themed professions in comparison with other career dolls and to determine their accuracy in meeting clinical and laboratory safety standards.
Design Descriptive quantitative study.
Setting Visual and data analysis of web searches.

Main outcome measures To identify the kinds of medical and scientific subspecialties that the Barbie dolls (and a comparison doll group) worked in; and to determine whether these medical professional and scientist dolls met laboratory and clinical safety standards. Additional data about doll demographics (ie, age, ethnic group, and sex) were also collected.

Participants 92 Barbie brand dolls were analyzed: doctor (n=53), scientist (n=10), science educator (n=2), nurse (n=15), dentist (n=11), and paramedic (n=1). 65 non-Barbie brand dolls were also analyzed for comparison purposes: doctor (n=26), scientist (n=27), nurse (n=7), dentist (n=2), engineer (n=2), and magnetic resonance imaging (MRI) technician (n=1) dolls.

Results Barbie brand medical professional dolls (n=80) largely treated children (66%, n=53/80), with only three (4%) medical professional dolls being directly depicted working with adults. Of the 12 scientist Barbie brand dolls, none met all proper personal protective equipment requirements related to hair and clothing. Barbie brand dolls often came with items, such as laboratory coats, microscopes, stethoscopes, and glasses, that children stereotypically associate with doctors and scientists. While comparison dolls offered a wider range of age and ethnic groups than the Barbie doll group did, the dolls similarly struggled to portray a wide range of medical and scientific subfields and most comparison dolls did not wear proper personal protective equipment.

Conclusions Medicine and science themed dolls help to inspire tomorrow’s medical professionals and scientists. All toy companies should ensure that future medical professional and scientist dolls meet clinical and laboratory safety standards and diversify the types of medical and scientific professions represented (especially among male dominated fields). For young girls’ sakes as much as her own, Barbie must keep shattering glass ceilings.

bmj-christmas-2023 Download

All opinions on this blog are my own

A Shout Out to My Girls: This one is for all the women that support others & see them as inspiration not competition

December 11, 2023 girlymicro General author, happiness, health, love, motivation, reflection-of-self, uncompromising

I was fortunate enough to be asked to record a podcast last week with the absolutely awesome Betty Adamou for her series Tales of Female Badassery. Just as we were prepping to record I was struck with a moment of panic. I didn’t know whether I was a Badass. I didn’t know if I’d every done anything that would make me a Badass. I called one my girls in a state of panic, she responded with ‘don’t be so ridiculous, you’re not only a badass, you’re one of the most badass people I know’.

It got me to thinking. I am super fortunate to be really close to my family and to have the wonderful Mr Girlymicro as my constant companion. In more recent years I have, however, also become aware of how wonderful it is to have a small tight knit group of women in my life. These are the people who understand if I don’t call them for months. The ones who know me well enough to know when to challenge and when to comfort. The ones who I can sit and watch bad movies with in pyjamas and who would never judge me for the state of my house. Some of them I have known for decades, others more like 5 years, but time doesn’t really matter. They are my girls. They get me, and this post is dedicated to them and why you should consider finding your own equivalents.

Constructive challenge

Not everyone has a Mr Girlymicro in their lives and to be honest we all need someone to call us on our BS sometimes. Having a small cicle that you trust completely, which have the ability to stop you in your tracks when you’re going down a cognitive rabbit hole is so valuable.

I suspect we’ve all been there, sounded off about X or Y, when suddenly someone trusts calls us out on what we are doing that could trigger that behaviour, or pushes us to understand why we are so triggered. This calling out opens up a whole new vehicle to understanding or route for a response that would not have been available to us otherwise.

In my case, my girls often join forces with Mr and mummy Girlymicro in asking me why? Why have I decided to take on yet another thing? Why do I think it’s needed? What extra will it add? What will I drop to enable me to take on the shiny new? What does it mean for them? Will they see even less of me now? Will I be even more distracted and do even less at home? These conversations can lead to me walking back commitments, or at least force me to articulate my thought process and gain a better understanding of where I actually am with my workload.

Unconditional support

The reason that constructive challenge can happen is because I know these guys are 100% on my side. They are unwavering. They know all the bad in me and choose me anyway. They can, therefore, be brutal about the truth when needed, as they are also around for the rebuilding that is sometimes required after being faced with a harsh truth.

This also means that I hear what they say. If they tell me someone is out of line and validate my feelings, I hear it more because I also know they would tell me if the opposite was true and I was the one who’d acted badly. To me, unconditional support isn’t about just giving me what I want to hear. It’s giving me what I need to hear in terms of the truth/reality check. They tell me both that I’m not superwoman, but also that I’m a god damn queen who can achieve anything she puts her mind to. Just not simultaneously.

Shared experiences

Not through any deliberate endeavour, but just because of how life has worked out, my girls all happen to be kick ass women who either work in STEM (science, technology, engineering and maths) or are STEM qualified. In fact, they are all coincidentally PhD qualified. I didn’t meet them all through science however. For instance, Diane, I met my first day at uni and has been keeping me sane for over 20 years. Claire (known as Dr Claire, as she was the first Claire with a PhD) I met because she was dating a friend of my future husband, the boyfriend exited the picture and we stayed friends. Claire (Captain Claire, due to our shared appreciation of Captain Jean Luc Picard) and I met over several bottles of wine when we were both doing our PhDs and have continued on the wine trajectory ever since. This means we have both a bunch of shared and different experiences.

Our shared experiences, linked to being women in science, mean that they can sometimes help me see challenges coming in a way I wouldn’t have anticipated. They can also share what did and did not work for them when they encountered something similar. We can, on occasion, also just rage about the injustice of it all in a way that enables us to put our feelings in a box and carry on regardless.

A different view of the world

I have some wonderful women in my world who I count as dear friends but whom I still work with. These wonderful women are often my go-to for support and guidance as they are emersed in my world. The difference between them and this group of girls is that we don’t work together, and have never worked together in the same department. This means that we took different paths through both work and life. We don’t just reinforce each others perceptions and bias therefore through having pre-established knowledge of the other people in each others lives or work. We have a bunch of shared experiences, but a lot of our progress has led us to very different places. Some of us have kids, some don’t, some of us still work academically or in science, some don’t. This breadth of experiences mean that they can sometimes offer a very different view to mine. They can point out nuance I would have missed or when my previous experience is biasing me to a current situation.

We also have very different ideas of what constitutes a good time. I’m a book, fire, sofa and afternoon tea kind of girl. Whereas the Claires would way prefer to be with their animals (chickens, wallabies, etc) and Diane would happily be walking through the Scottish countryside. This is also helpful. It has always pushed me to try things I wouldn’t have. Once it pushed me to try camping. This was a mistake. Camping was a step too far. They love me anyway.

Parachute provision

I’ve written before about my tendency to shame spiral. I’m not alone. Captain Claire and I are known to call each other up mid shame spiral and offer each other a parachute outta there. We talk through what we’ve done, talk through the possible consequences, and how we might act or handle things differently next time, in a space of acceptance without judgement. It’s this last piece that is key. We’re not trying to ‘fix’ each other, just support each other by providing a safe space for verbal reflection and to articulate our fears, whether rational or not. From my perspective, this often permits an early exit from the spiral combined with some centering and learning. What more could a girl ask for?

Sometimes, we all cry

That same space of zero judgement is also important as it provides a space where you have licence to just feel. Sometimes, I have to ride the wave of emotions to process them and get through to the other side. It’s no secret to the readers of this blog that there have been some tough times in the last few years. Having a space where you can just have freedom to express that you are angry or upset by the state of the world or the way you have been treated professionally is so special. I have this with Mr and mummy Girlymicro as well, but it helps them to be able to share the load, especially when things can go through intense periods. Sometimes, I just need to cry and say that things are unfair, and then I get it out of my system and find the emotional band width to remember my why and can get back on with the fight.

Borrowed courage

When I phoned up Dr Claire and declared ‘I’m just not a badass’, her first response of ‘hell yes you are’ gave me courage. It made me brave enough to go ahead and record something I was hesitant about. This is what my girls do. They loan me courage when mine fails me. When my imposter syndrome or my fear tells me I can’t, they are always there to tell me I can. When I receive awards or recognition and I ask ‘why me’, they respond ‘because’. They see me when I cannot see myself. They will tell me to ignore the fear and just get on with it. They will challenge me when I’m avoiding things because I’m not brave enough and loan me the courage I need to do what is needed. When required, they bring out the bad ass warrior in me.

Courageous authenticity

The validation I am lucky enough to receive from my family and my girls is important for another reason. They make me feel like it’s OK for me to be myself, not some projected version of myself. I’m pretty open in this blog about who I am, how I feel, and how I respond to challenges. I’m also (I hope) pretty honest about my personal flaws and areas that I’m trying to grow and improve around. This blog wouldn’t be possible without having people around who not only validate that that message is OK, but that it is actually important and helpful to talk about these things.

There are days for all of us where we can’t love ourselves. Days where all we can see are our flaws and none of our strengths. Days when we compare and we just don’t stack up. Having people in your world who also see and acknowledge these weaknesses, love you anyway, and tell you you have value even in their presence is one of the greatest gifts we can receive from another person. It enables you to still be who you are even when that may be the last thing you want to be. To continue to work on being unapologetically authentically you.

Mutual appreciation society

One of the best things about these relationships is that they are bi-directional. Most of the time, when one of us is having a bad time, the other is doing OK and can be there to lift the other up. On the occasions where we are both just going through it, then a shared pit of despair can still provide comfort. (We’ve decked ours our with pillows, blankets, and everything). I think these ladies rock it. I trust them completely. I trust them to call me out and challenge me, which means when they validate my other feelings, I believe that too. I love them and consider myself blessed to have them in my life. I also hope that I am there for them as much as they are there for me.

My girls and I aren’t in competition with each other. We’re all on different paths. We value different things, and that’s not only OK but joyous! It doesn’t matter who is achieving what. It doesn’t matter if that’s getting the kids to school on time, or getting out of bed and just making it to work when we’re having a bad time and just wish to hide from the world. All of it is valid and worth celebrating. When they were having kids and I was finding it hard as I was still working through my own situation, they were always mindful but still knew that I was genuinely happy for them. One thing does not obliviate the other.

Distilled awesome

So, to end, I want to say thank you. Thank you to the women out there supporting other women. Thank you to the ladies who straighten my crown even when I don’t realise it’s crooked. Thank you to my girls, the one’s who I cry, scream and cheer with. You are distilled awesome and I will never be able to truly describe the difference you’ve made to my life and how grateful I am to have you on this journey with me. I may be absent for months, I may be a special kind of crazy, but know I am always here for you!

All opinions in this blog are my own