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By: Abul K. Abbas, MBBS

  • Distinguished Professor and Chair, Department of Pathology, University of California San Francisco, San Francisco, California

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Some phthalates have been identified in samples of waste plastics and recycled and virgin plastics (Pivnenko et al medications covered by medicare buy generic strattera canada. Research also showed that phthalates were possibly added in the later stages of plastic product manufacturing medicine x boston buy strattera online from canada, such as labelling medicine pills 10mg strattera overnight delivery, gluing symptoms 16 dpo purchase strattera 40 mg line, etc, and are not removed following recycling of household waste plastics (Pivnenko et al. In addition, a recent study led in the residential and agricultural soils from Guiyu, Shantu (China) the largest e-waste processing and recycling areas in the world, indicated that electronic waste (e-waste) recycling was a substantial source of phthalate contamination in the environment (Zhang et al. Finally, due to their use as plastic softeners, phthalates may also be found in cosmetics as leaked materials from the contact with plastic materials in the production process and also during storage (Fromme 2019). The main route of exposure is food ingestion for most phthalates, with some found at higher levels in fatty foods. Infant exposure can take place via breast milk and an important exposure route for children is mouthing of toys, as well as other products. Foreseeableglobal trends Over the past decade, the use of some phthalates in certain applications has been restricted in different regions of the world. Phthalates are a large class of chemicals, only some of which have been studied to date, for which some have adverse effects on human health (Shu et al. Costs of inaction A study on benefits from chemicals legislation (Amec Foster Wheeler et al. Benefits in terms of avoided medical costs, lost economic productivity and other indirect costs, were estimated at 7. A comprehensive but not exhaustive overview of existing instruments and actions on sound management of phthalates. Use of these in medical devices and monitoring and control equipment is given an extension for substitution of 22 Jul 2021. A subsequent ministerial resolution establishes a certification system for products and toys regulated under Ministerial Resolution 583/08. Importers shall make tests for phthalates and request a certification (Ministry of Health of Argentina 2011). Uruguay Technical regulation for manufacture, import, and sale of toys Decree 388/05, 2005, and its amendments establish requirements and certification system for toys, including for phthalate content (National Customs Directorate, Uruguay 2005). Nordic Swan) criteria include the requirement that phthalates shall not be present in the dyes and adhesives used, nor in indoor paints and varnishes (Nordic Ecolabelling 2018; Nordic Ecolabelling 2019). Articles covered include sport equipment (bicycles, golf clubs, racquets), household items (utensils, trolleys, walking frames), tools, clothing (including footwear, gloves and sportswear) and other apparel (watch straps, wristbands, masks, headbands). A brief overview of existing assessments of environmental and human effects of triclosan by national governments and intergovernmental institutions. Triclosan exposure also results in modest decreases in serum thyroid hormone thyroxine (T4) levels. However, the overall database does not support the effects of triclosan on thyroid function as a critical effect for risk characterisation in humans. Based on available information, induction of antimicrobial resistance from current levels of triclosan has not been identified as a concern for human health. Adverse effects that have been observed include reduction in growth, reproduction and survival, and there is evidence of effects on the endocrine system at environmentally relevant concentrations. Triclosan can also accumulate in fish, and there is evidence of bioaccumulation in algae and aquatic invertebrates. Continuous releases from products and wastewater treatment plants (effluents and biosolids) "result in the ubiquitous presence of this chemical in the environment". Toinformdecisionmakingonsingle-usemedicaldevices and other items that use triclosan in medical settings Clinical effectiveness and safety for hospitalized patients "Limited evidence of variable quality" suggested that triclosan-coated sutures "had outcomes that were better or not different than patients treated with uncoated sutures". These included lower use of antimicrobials after operations, fewer outpatient visits and lower readmission rate, but no differences in quality of life, post-operative mortality, Clostridium difficile infections, and other outcomes when compared to untreated sutures. If these limited screening study values are representative of Australian levels, then the risk does not warrant regulatory action at this stage. However, there is uncertainty that these values are characteristic of the full range of Australian situations. However, triclosan is expected to sorb strongly to sediment and sludge and no significant release of triclosan into the aquatic or terrestrial environments is expected based on the registered uses (triclosan as a materials preservative is registered for use only in the manufacturing of textiles and plastics. Little, if any, of the remaining triclosan will leach out of these products during use). It should be noted that most of the triclosan released into the environment is from non-pesticidal uses (health care products). Efficacy was demonstrated only for Gram-positive bacteria and not against Gram-negative bacteria, which was considered insufficient for active substances used in disinfectants. Pure triclosan is irritating to skin and eyes, whereas the low concentrations used in personal hygiene products do not pose an irritant hazard. Based on the specific evaluated use, no possibilities for any risk mitigation measures seem to be realistic. No information was identified to indicate if or how regulatory action on triclosan in specific countries. The product category with the highest share of triclosan-containing products is personal hygiene products, particularly deodorants (Lee et al. Imports of triclosan into Australia were reported to be about 27 tonnes in 2005 (Australian Government 2009). It has been used in a wide variety of consumer products (including soaps, facial wash, dishwashing liquids, laundry detergents, toothpaste, mouthwash, cosmetics, deodorants, shaving cream, feminine hygiene products, skin cream and antiseptic first aid products) and as a material preservative (for example, in toys, mattresses, toilet fixtures, clothing, furniture fabric, kitchen utensils and paints) and in hand washes to prevent the spread of bacteria. Key uses/applications End-of-life data the disposal/release of triclosan-containing consumer products (soaps, detergents, cosmetics) is predominantly through rinsing down drains, resulting in delivery to wastewater treatment plants if available. Incomplete removal of triclosan from wastewater effluent and the applications of triclosan-containing sewage sludge to agricultural soils can therefore lead to triclosan being distributed in aquatic and terrestrial environment (Dhillon et al. Dermal contact, inhalation of dust, biosolids, domestic wastewater and solid waste are also routes of consumer exposure and occupational exposure for workers who make or handle these products and wastes. Main exposure sources and pathways - High concentrations of triclosan (1,570 ng/mL) were found in saliva immediately after brushing teeth using a commercial toothpaste with 0. Industrial wastewater may also be a source of exposure or pathway to the environment. Healthcare settings use medical products with triclosan as chemical disinfectant for surgical gloves, detergents to clean bedpans and other surfaces, and implantable devices or sutures. These also result in solid wastes, wastewater and other materials that can result in dermal, inhalation and other exposures, not only for workers but for patients (and eventually the environment). For example, after several washes, nearly all triclosan in fabrics was released into washing water in Sweden (Swedish Chemicals Agency 2011). Triclosan has been detected at levels of microgram per litre or per kilogram in sewage treatment plants (influents, effluents and sludges), natural waters (rivers, lakes and estuarine waters) and sediments, as well as in drinking water (Bedoux et al. Examples of measurements of triclosan in the environment, biota and humans across the globe. John River, Grand River, Thames River, Red River, and Wascana Creek,Canada (Lalonde et al. A comprehensive but not exhaustive overview of existing instruments and actions on sound management of triclosan. Canada regulates cosmetics, non-prescription drugs and natural health products (Health Canada 2019). Andean Community countries Manufacture and import of cosmetics Resolutions of the Andean Community that restrict various ingredients in antibacterial soaps, including triclosan.

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As a location from which to symptoms nausea headache generic 10mg strattera visa address the emergence of critical psychology medications by class best strattera 10 mg, one of the central concerns of this chapter is the Eurocentrism that identifies our geopolitical region through Westernized understandings of land treatment of pneumonia cheap 25 mg strattera mastercard, and the relationships between people and institutions medications ritalin discount strattera 10 mg line. Globalization foregrounds questions that have been crucial to the emergence of critical psychology: how do social power relations, ideologies, and discourses produce technologies of knowledge production, and conceptualizations of the subject within historical, cultural, and social relationships, and how are psychology and critical psychology implicated in these productions? We are particularly concerned with some of the intimate relations of globalization: neoliberalism, postcolonialism, Western hegemony, and everyday practices of normalization. It is characterized by a kind of embeddedness that is specific to spaces (social relations between people and institutions) and places (specific histories of territorialization and relationships to home and land). Emerging anew from modernity through novel technologies of governmentality, neoliberalism extends individualism and intensifies liberalism. From our location, we notice a particular repetition in this expansionist mode of global capital, not quite uniform but dominant and hegemonic, in that the neoliberal citizen is an individualized subject characteristic of a Eurocentric gaze on a particular social body. Thus neoliberalism and globalization, multiple and fragmented in their processes, reproduce a hegemonic Western mode of subjectification to the social power relations of individualist culture. In our geopolitical location, the significance of Eurocentrism in techniques of subjectification to dominant Western ideologies of individualism, repeated through neoliberal forms of governmentality, is intimately connected to our specific places in postcolonialism. The postcolonial has been variously engaged to articulate the concerns of a so-called Third World in the political imagination of the West. Moreton-Robinson (2003) argues that nations where white settlers are not dominant in government, such as Malaysia, are differently postcolonial from Australia, where colonial settlement is firmly established, and entrenched, in government. Aotearoa/New Zealand, likewise, is governed and dominated by white settler peoples, despite The Tiriti o Waitangi/Treaty of Waitangi, which established a historical agreement that promised partnership in the development of our nation (McCreanor 1993; Morgan, Coombes, and Campbell 2006). In this sense, colonization continues, and the postcolonial marks a relationship that is governed by, and normalizes, whiteness. Here, the specific histories of territorialization are bounded by ongoing colonization and marked by differences in relationships to land among indigenous and settler peoples. In our region, colonization has also dispossessed and dislocated settler peoples, including peoples of the Pacific Islands who constitute marginalized diaspora within the national boundaries of Australia and New Zealand. There are complex histories in relation to Pacific Island settlers in both nations. For instance, the Torres Strait Islands are not independent nations, as are some other Pacific Islands. Torres Strait Island people are positioned as indigenous Australians, although many live away from their islands, on the mainland (Dudgeon et al. Among the settler peoples there are plentiful examples of non-indigenous peoples who are marginalized by the dominance of white colonial governance and Eurocentric normalization. The legacy of multiple dispossessions and differences across the South Pacific constitutes our place as both a condition and a critique of postcolonial discourse, fracturing any assumption that there could be a unified relationship between histories of territorialization and the postcolonial. Within these fractured conditions there are specificities marking the relationship between peoples and institutions of our geopolitical region. Critical attention to whiteness and its normalization opens space for counter-hegemonic resistances to Eurocentric domination, including the authorization of non-dominant epistemologies and marginalized social texts. However, this opening is tenuous, dependent on cultural practices of knowledge production that are materially conditioned through social power relations of dominance. These experiences testify to the ongoing privilege of Western ways of knowing, and the iteration of Eurocentric representations that risk perpetually reproducing the subjugations of colonialism. Normalization of Western discourse, as a technique of subjectification, intersects with the neoliberalism and globalization that hold us to our place in postcolonialism. Our specific risks for critical psychology are concerned with ongoing colonization through re-inscribing white authority over the non-West. The risk of not engaging with postcolonial theory is the risk of constituting differences among peoples through knowledge production processes that have dehumanized indigenous peoples (Dudgeon and Fielder 2006; Smith 1999). The risk of engaging postcolonial theory is a risk of writing back to colonial centres and reproducing relations of centre and margin that function to normalize Eurocentric discourse. The critical, too, risks overwriting our differences with sameness derived from reifying a partial position within the discursive, material, and cultural constituents for articulating interrelationships of mutuality. The emergence of critical psychology into the discipline in the late 1980s drew attention to the relevance of psychology in its sociopolitical context. Early feminist engagement with post-structuralist theory also generated critical discursive research agendas that resist the dominance of post-positivist knowledge production. Problematizing normative heterosexism, Gavey and her colleagues have challenged cultural narratives of sexuality and sexual violence. Alongside critical engagements with heteronormativity, Gavey interrogates the theoretical terms that enable critical feminist engagements to write back to the masculine privileges of European cultural values. Sex and the body are particular concerns that shape arguments resisting the naturalistic assumptions of research that conflates biology and embodiment while normalizing heterosex. Gavey (2005) engages Foucauldian theory to theorize sex and the body as socially and discursively constituted while simultaneously materially effective; constitutive of bodies, sexualities, and subjectivities. Writing back to Eurocentric masculinism, Morgan (2005) interrogates critical psychological engagements with theorizing bodies to question how the discourse of embodying domination informs transformations of gendered social power relations. Challenging the sadomasochistic positioning of women in intimate violent relationships, she draws on psychoanalysis to resist Anglo-American traditions of analyzing masculinist privilege in the representation of women (Morgan 2011). Accommodating feminism within mainstream methodologies poses little challenge to psy-discourse in an era of neoliberal postfeminism, yet critical feminism interrogates complicity with neoliberalism, particularly notions of empowerment, agency, and choice. This work intersects with critical feminist concerns with norms of gendered health and sexuality that also characterize writing back to Eurocentrism in our geopolitical place. Braun 2010; Jackson and Westrupp 2010; Jackson and Weatherall 2010; Lyons 2009; Ussher 2011). The disciplinary space in which gendered social power relations accommodate feminist research that does not challenge postpositivist commitments also normalizes racial, ethnic, and class differences through notions of deficit. As Moeke-Maxwell (2005) argues, in Aotearoa/New Zealand, feminism has not engaged critical discursive approaches to theorize the complex positioning and subjectivities of Maori women. Racism and racist discourse saturate Eurocentric representations of difference through constituting disease, mental disorder, violence, and poverty, and positioning indigenous peoples as lacking (Groot et al. In discursive projects focused on the material and social practices of everyday life and the meanings of medication and food, Chamberlain and colleagues. Insistence on the social enables attention to specific effects of dominant Eurocentric biomedicine on Maori whanau (Hodgetts et al. In our geopolitical region, critical health psychologists problematize the racism of discursive practices that are linked to colonial practices of governance, such as the Tohunga Suppression Act (1907) that restricted the use of indigenous healing systems (Mark and Chamberlain 2012). In the wake of these explicitly colonial strategies, the turn to language in critical social psychology has focused on writing back to discursive practices of everyday racism. This work traces a shift from blatant white supremacy to neoliberal egalitarianism and individualism that operates as more subtle racism. Acceptable forms of defining, stereotyping, and criticizing non-white others are analyzed as practices of ongoing colonization. The success of critical social psychology is evident in the diversity of approaches to discourse analysis that have propagated since critical psychology emerged (Augustinos 2013). In our geopolitical region, discourse analysis is debated, defined, and characterized within the context of methodological resistances to dominant post-positivism, as it is elsewhere. Yet, methodological debates risk establishing hierarchies of criticality even on the margins of psychology. In this context, critiques of hegemonic whiteness, racialized embodiment, and symbolic racism that centre on writing back to racist discourse simultaneously challenge research that has constructed indigenous others as inferior while participating in research that marginalizes indigenous ways of knowing. In the wake of globalization, the construction of deficits is contextualized by spaces where risks are characterized as dangerous, and proliferating. Within Eurocentrism, the discourses that constitute racial and cultural others as lacking in health, morality, or self-discipline are also complicit with promoting modes of surveillance for the sake of safety. Opening spaces Critical psychology in our region does not only engage in writing back to Eurocentrism. There is also work that focuses on opening up spaces for new forms of transformation. The intersections of contemporary postcolonial and neoliberal governmentality are concerns of emerging critical community psychology.

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Vignettes 9-Year-Old Boy Riley is a 9 year-old Caucasian male with a history of attention deficit hyperactivity disorder and significant behavioral and learning problems treatment of criminals cheap strattera online master card. Riley was the product of a twin birth medications to treat bipolar disorder buy genuine strattera, and both he and his fraternal twin were adopted at 1 month of age by his current adoptive parents treatment 4 ulcer purchase discount strattera line. The patient has had no major illnesses symptoms at 6 weeks pregnant cheap 10 mg strattera otc, medical hospitalizations, surgeries or head traumas. There are no hearing problems; however, Riley has mild strabismus and is nearsighted, for which he requires glasses. Riley currently attends the Kable Elementary School in a third grade, special day class. He receives occupational therapy due to difficulty in fine motor skills and coordination. At school, Riley has had problems with hyperactivity, distractibility, inattention, and impulsivity, for which he has received accommodations. Riley is reported to have poor social skills, repetitive behavior, poor body boundaries, sensory sensitivities, and concrete thinking. There was considerable variability across various domains of functioning, with a Verbal Comprehension Index of 75, Perceptual Reasoning Index of 96, Working Memory Index of 80, and Processing Speed Index of 86. Subtest standard scores are: Communication 72; Daily Living 58; and Socialization 64. Various neurocognitive tests reveal problems in executive memory and language functioning. He has problems with dysregulation and explosive behavior characterized by discrete episodes of failure to resist aggressive impulses resulting in purposeful destruction of property at home and at school and assaultive acts toward parents. These aggressive outbursts were noted at the age of 6, when patient would throw toys and other objects at his mother or smash toys on the floor. When asked to do something at home that he does not want to do, he will yell, swear, slam a door, punch furniture, or hit and kick his parents. Mother notes that 53 Riley frequently lies and has taken money from her purse to give to other children. Mood symptoms include rapid changes in affect, trouble sleeping, poor appetite, and irritability alternating with pressured speech and grandiosity. This patient was examined according to the criteria set forth in the 1996 Institute of Medicine Report refined by Hoyme, May, Kalberg, et al. Prenatal Alcohol Exposure: Known Diagnosis: Alcohol-Related Neurodevelopmental Disorder, Prenatal Alcohol Exposure Known Recommendations Vignettes 1. It is recommended that Riley follow up with an outpatient psychologist for individual supportive psychotherapy. Riley would benefit from individual therapy focusing on social skill-building and reducing maladaptive, unsafe behaviors. This treatment should include role modeling and practice of appropriate behaviors both in the office and in real-life situations. In order to promote social development, Riley will likely benefit from social skills training to help him develop ageappropriate interaction skills. During these social skills lessons, planned interactions with typical peers (intensive individual or group instruction) will focus on teaching Riley to recognize social cues and engage in ageappropriate social interactions. Parent training should stress consistency and giving clear instructions, as well as teaching basic principles of reinforcement and contingency management. It is recommended that Riley receive ongoing supports within a small school setting to facilitate his academic progress, ensure his ability to access the curriculum, and direct and monitor appropriate participation in goal-directed activities. He will continue to require instructional accommodations, such as, but not limited to, supports for written expression; allowances for oral information to be repeated and broken down into smaller sections; and extended time to complete certain tasks as well as to respond to information. In addition, it is recommended that Riley have opportunities for individualized contact with a designated teaching staff. He will likely require, and clearly benefits from, monitoring during his school day in order for him to maintain adaptive participation in goal-directed activities. Given that Riley still exhibits impulsivity, maladaptive behaviors, concentration and attention regulation problems, and social communication problems; it is recommended that he see a child psychiatrist for psychotropic medication management. During school I thought I was dumb but, as I got older, I was able to do some things. I had a time getting my homework done and getting all my stuff together every day. I miss a lot of meetings and am late for some things; once I went to a meeting 2 days early. I need services, and they are always trying to take them away when I get to doing well. Vignettes 56 "The Courage to Come Back" Sasha is a 38-year-old mother of six who had her first contact with our inner-city outreach team shortly after the birth of her youngest child. Sasha now feels that her community and family (specifically her dad) and the professionals who helped her access community programs have helped her "with the courage to come back. She has a scar on the left side of her chest and was told she had heart surgery as a baby. Sasha and her brother were in and out of different foster homes while living with their mother, sometimes together, but often apart due to their behavior. Most of these foster placements were "closer to home," thanks to her dad and his coworkers, who lobbied to keep the kids connected to him. After repeating grade 7 in behavioral modification class, she was in and out of youth court services, and attended three different high schools. She got pregnant at 16 in grade 10 and delivered her first daughter shortly before her mom died. He started to work at the local community centre and had frequent contact with his grandkids. And there was an open door, close to home, that she could walk through without being judged. They all seemed to understand her, and accommodated for her forgetfulness and weak executive function and adaptive skills. That was the first step-to acknowledge and receive support to allow her to be a "special needs parent. Sasha now lives with her three youngest kids in the same housing co-op where she grew up. Sadly, her 17-year-old son, also abused in foster care, is now in jail and has never been formally assessed. Last week, the principal gave our team the "thumbs up", and exclaimed, "I will always have time for Sasha and her kids. Sasha explained to us after her award, "I always knew I had something that made it [school] harder, but my courage came from my dad, who never gave up on us. Sasha agreed to have her story told to help others who need support to find "the courage to come back. Most children we see in clinic have a multitude of other risk factors, including prenatal exposure to illicit drugs, poor prenatal care, multiple home placements, and/or physical/sexual abuse. She had some unusual difficulties sleeping as an infant and had problems with vomiting her feedings. She has some unusual behaviors-hand- wringing and head tipping-particularly if she is stressed or excited. Sarah can definitely learn and has some real strengths, such as puzzles, but often is extremely fearful of new situations. Despite her ability to learn new things, she does have problems recognizing consequences of actions and learning from experience. Sarah is also described as having poor social skills and is starting to feel socially isolated at school. She has poor balance, some delayed motor skills-most notably she has difficulty using silverware to eat. Sarah has been receiving special education services (including reading, math, written language) in school since preschool. Sarah has also been diagnosed with a sensory integration disorder, an auditory processing disorder, and a social communication/pragmatic language disorder. Sarah scored significantly below average (< 4th percentile) in all areas of the Mullen Scales of Early Learning.

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For specific in-depth information treatment algorithm cheap strattera 25mg with amex, readers are advised to world medicine order 25 mg strattera mastercard consult individual references symptoms 0f ms purchase strattera, including review articles symptoms 89 nissan pickup pcv valve bad purchase strattera 25mg line. The tumbling motility is characteristic of Listeria and often used as a conventional marker for Listeria identification. On agar media, Lm colonies are translucent with a characteristic blue-green sheen when viewed by obliquely transmitted light. Lm can also be cultured in defined synthetic and semi-synthetic media, but growth rates are much slower than in nutrient-rich media (1,2). Taxonomy and Biochemical Properties Lm has been classified together with Lactobacillus, Erysipelothrix under the genus Listeria in the family Corynibacteriaceae. Lm is catalase positive, ferments rhamnose, dextrose, esculin, and maltose, but does not ferment xylose and manitol. These biochemical properties are used for the differentiation of Lm from other members of the genus Listeria and from related organisms like Erysipelothrix, Kurthia, Brochothrix, and Streptococcus. In this test, unlike other hemolysin-producing Listeriae, Lm produces a synergistic zone of hemolysis in presence of Staphylococcus aureus hemolysin on sheep blood agar (1,2). Based on macrorestriction enzyme (NotI and SseI) fragment length analysis, the total length of a Lm serotype 1/2c strain genome was calculated to be 3150 kb (6). Based on the data published by these three groups, a schematic diagram of the Lm physical genomic map is presented in Figure 1. Outside circle represents Scott A chromosome (8), while the inside circle represents 1/2c (6) and 1/2a (7) chromosomes. Fragments containing the virulence gene clusters also contain inlA and inlB genes. Whether these differences between serotype 1 and 4 really represents distant genetic relatedness or not requires further studies and sequencing information of some conserved genes. Some of these plasmids are cryptic (9a), while others carry antibiotic resistance (11) and cadmium resistance genes (10). Typing Based on somatic and flagellar antigens, Patterson first proposed four serotypes to classify all Listeriae. Later, Donker-Voit and Seeliger expanded the scheme into seven serotypes, some containing subtypes. The serotypes are not restricted to particular species of Listeria except serotype 5, is only reported in L. To overcome this problem and to aid in the outbreak investigation, several other typing schemes, including phage typing, isoenzyme typing, monocine typing, and plasmid typing, were developed. Survival and Growth Lm has been isolated from a variety of foods containing dairy, meat, seafood, eggs, and vegetables (1,2). These products include processed foods that require cooking or minimum preparation or are ready to be consumed. Because all cooking processes require some amount of heating, it is generally accepted that cooked food will contain the least amount of viable listeriae. The growth rate at low temperatures commonly used for storage depends on nature of food. Although experimentally Lm was not found to be unusually heat resistant, the involvement of pasteurized milk in an outbreak in the United States created great interest in studying the heat resistance of this organism and reevaluation of the commercial milk pasteurization process to make sure that the current pasteurization process is adequate for killing. Data collected by different researchers using a variety of experimental conditions indicated that Lm is not unusually thermotolerant and that current milk pasteurization protocol is adequate (17). The survival at low temperature depends on the amount of moisture, pH, and osmolarity of the food (19,20). Of particular interest is the description of heat-shock process and heat-shock genes in thermotolerance (27,28). Several researchers identified genes that alter the survival and growth of Lm at low temperatures (29,30). Further studies are needed to understand the mechanisms and factors that control the ability of Lm to grow and survive at low temperatures. Lm has been isolated from various acidic foods including sausage, cheese, cole slaw, etc. From these and other studies, it was argued that Lm would probably be inactivated more easily in stomach and intestinal pH than Shigella and E. The implication of this finding is that Lm in low-pH food would probably have lower infective doses than Lm in neutral- or high-pH foods. Based on the susceptible population, the human listeriosis can be classified into two groups: adult and neonatal listeriosis. Most adult listeriosis cases are reported to have underlying diseases leading to immunocompromised state, although a few outbreaks involving "healthy" individuals have also been reported (3,4). During the initial enteric phase, patients experience mild flu-like symptoms with occasional diarrhea. Pregnant woman infected with Lm may have an early onset of flu-like symptoms, which are often misdiagnosed as influenza. Although most pregnant women recover without any complications, maternal infection can lead to neonatal infection. The invasive phase of adult listeriosis is characterized by septicemia, meningitis, and endocarditis. Although early diagnosis can be successfully treated with antibiotics, the fatality rate of untreated or late-treated meningitis cases is often as high as 70%. Several recent outbreaks have demonstrated that Lm infection can result in febrile gastroenteritis and the organisms can be isolated from stool specimens (4). Neonatal listeriosis accounts for almost 40% of all human listeriosis cases (2,4). This form of infection, resulting in pustular skin lesions, is called granulomatous infantiseptica. Even with the availability of antibiotic therapy, 10% of late-onset cases die because of the advanced stage of the illness. It is likely that some of the cases became infected during passage through the genital tract. Also important in this process are the host factors, which modulate the susceptibility to Lm infection.

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