ASM.org - Do you think that your famous brand of bottled water is cleaner than tap water? A recent study finds that heterotrophic bacteria counts, in more than 70 percent of bottled water samples, exceed the recommended limits specified by the United States Pharmacopeia (USP). Researchers from Ccrest laboratories reported their results at the 110th General Meeting of the American Society for Microbiology in San Diego, CA.

“Despite having the cleanest tap water a large number of urban Canadians are switching over to bottled water for their daily hydration requirements. Unsurprisingly, the consumer assumes that since bottled water carries a price tag, it is purer and safer than most tap water,” says Sonish Azam, a researcher on the study.

Regulatory bodies such as the Food and Drug Administration (FDA), Environmental Protection Agency (EPA) and Health Canada have not set a limit for the heterotrophic bacteria counts in bottled drinking water. However, according to the USP not more than 500 colony forming units (cfu) per milliliter should be present in drinking water.

The study was initiated in response to a Ccrest employee’s complaint of fowl taste and sickness after consumption of bottled water at the company. Azam and her colleagues Ali Khamessan and Massimo Marino randomly purchased several brands of bottled water from a local marketplace and subjected them to microbiological analysis. They discovered more than 70 percent of famous brands tested did not meet the USP specifications for drinking water.

“Heterotrophic bacteria counts in some of the bottles were found to be in revolting figures of one hundred times more than the permitted limit,” says Azam. In comparison the average microbial count for different tap water samples was 170 cfu/mL.

Azam stresses that these bacteria most likely do not cause disease and they have not confirmed the presence of disease-causing bacteria, but the high levels of bacteria in bottled water could pose a risk for vulnerable populations such as pregnant women, infants, immunocompromised patients (such as post-transplant patients and more advanced HIV patients) and the elderly.

“Bottled water is not expected to be free from microorganisms but the cfu observed in this study is surprisingly very high. Therefore, it is strongly recommended to establish a limit for the heterotrophic bacteria count as well as to identify the nature of microorganisms present in the bottled water,” says Azam.

ASM.org - Exposure to specific bacteria in the environment - already believed to have antidepressant qualities - could increase learning behavior, according to research presented at the 110th General Meeting of the American Society for Microbiology in San Diego, CA.

“Mycobacterium vaccae is a natural soil bacterium which people likely ingest or breath in when they spend time in nature,” says Dorothy Matthews of The Sage Colleges in Troy, New York, who conducted the research with her colleague Susan Jenks.

Previous research studies on M. vaccae showed that heat-killed bacteria injected into mice stimulated growth of some neurons in the brain that resulted in increased levels of serotonin and decreased anxiety.

“Since serotonin plays a role in learning we wondered if live M. vaccae could improve learning in mice,” says Matthews.

Matthews and Jenks fed live bacteria to mice and assessed their ability to navigate a maze compared to control mice that were not fed the bacteria.

“We found that mice that were fed live M. vaccae navigated the maze twice as fast and with less demonstrated anxiety behaviors as control mice,” says Matthews.

In a second experiment the bacteria were removed from the diet of the experimental mice and they were retested. While the mice ran the maze slower than they did when they were ingesting the bacteria, on average they were still faster than the controls.

A final test was given to the mice after three weeks’ rest. While the experimental mice continued to navigate the maze faster than the controls, the results were no longer statistically significant, suggesting the effect is temporary.

“This research suggests that M. vaccae may play a role in anxiety and learning in mammals,” says Matthews. “It is interesting to speculate that creating learning environments in schools that include time in the outdoors where M. vaccae is present may decrease anxiety and improve the ability to learn new tasks.”

Providing single lens distance glasses to older people who wear multifocal glasses and who regularly take part in outdoor activities is a simple and effective way of preventing falls, concludes a study published by the British Medical Journal.

However, the researchers warn that this strategy may not be appropriate for frailer people who spend more time indoors.

Presbyopia (a progressively diminished ability to focus on near objects) is the most common form of impaired vision in older people. To correct for this condition, people are either prescribed separate single lens glasses for distant and near vision or, for convenience, a single pair of multifocal (bifocal, trifocal, or progressive lens) glasses.

Multifocal glasses have benefits for tasks that require changes in focal length, such as driving, shopping and cooking. But they also have optical defects which can impair balance and increase the risk of falls in older people.

So researchers in Sydney, Australia set out to test whether giving older people an additional pair of single lens distance glasses for wearing when outdoors or in unfamiliar settings would help to reduce falls.

The study involved 606 people who were at high risk of falling (either aged 80+ years or aged 65+ years with a history of falls). All participants used multifocal glasses at least three times a week when walking outdoors and did not use single lens distance glasses.

Participants were randomly split into an intervention and a control group. After an initial examination by an optometrist, 305 intervention participants were prescribed a pair of single lens distance glasses for wearing outdoors and in unfamiliar settings, and were instructed in their use. They were also shown how multifocal glasses can increase the risk of falls.

The remaining control participants had the same optometrist examination as the intervention group but were not provided with single lens glasses and received no falls prevention advice.

Participants were monitored for 13 months. During that time, total falls in the intervention group were reduced by 8 percent compared with the control group. For those who regularly went outdoors, all falls, outside falls and injurious falls decreased significantly - by about 40 percent. However, for those who spent more time inside, outside falls increased significantly.

The intervention did not influence physical activity or improve quality of life.

Based on these findings, the authors recommend that older people who take part in regular outdoor activities should be provided with single lens distance glasses for outside use when they are prescribed their first pair of multifocal glasses. However, those who undertake little outdoor activity should use multifocal glasses for most activities, rather than using multiple pairs of glasses.

In an accompanying editorial, Professor John Campbell and colleagues at the Dunedin School of Medicine in New Zealand say that correcting vision can help lower the likelihood of a fall, but that any changes should be introduced step by step in a planned manner so that a person is not overwhelmed. They also recommend good communication between doctors and optometrists when considering vision, glasses and the risk of falls (Courtesy of EurekAlert!, a service of AAAS).

Nottingham.ac.uk - The type and dosage of statin drugs given to patients to treat heart disease should be proactively monitored as they can have unintended adverse effects, concludes a new study published by the British Medical Journal.

Researchers at The University of Nottingham found that some statins can lead to an increased risk of liver dysfunction, acute renal failure, myopathy and cataracts in patients.

Cardiovascular disease is a leading cause of premature death and a major cause of disability in the UK. The use of statins is often recommended to reduce the risk of cardiovascular disease among high risk patients.

Julia Hippisley-Cox, professor of clinical epidemiology and general practice, and Carol Coupland, associate professor in medical statistics, both at The University of Nottingham, wanted to measure the unintended effects of statins on certain clinical outcomes, taking into account the type, dose and duration of use.

They studied data collected from 368 general practices contributing to the QResearch database on 2,004,692 patients aged 30-84 years including 225,922 patients who were new statin users and prescribed a range of statins. The patients’ adverse outcomes were studied from January 2002 to June 2008.

The researchers estimated the effects of type, dose and duration of statin use on clinical outcomes that have been associated previously with statins and then calculated the numbers needed to treat and harm.

They found there was no significant association between use of individual statins and risk of Parkinson’s disease, rheumatoid arthritis, venous thromboembolism, dementia, osteoporotic fracture, or many cancers including gastric, colon, lung, renal, breast or prostate. There was a reduced risk associated with statin use for esophageal cancer.

There was, however, an increased risk associated with using statins for moderate or serious liver dysfunction, acute renal failure, moderate to serious myopathy and cataracts and evidence of a dose response for acute renal failure and liver dysfunction with higher doses being associated with greater risk.

Adverse effects were similar for all of the different statins taken except for liver dysfunction, where the highest risks were found for fluvastatin. All of the increased risks persisted during the treatment, but were highest in the first year.

Overall, for every 10,000 high risk women treated with statins, there would be approximately 271 fewer cases of cardiovascular disease, 8 fewer cases of esophageal cancer; 74 extra patients who experience liver dysfunction;  23 extra patients with acute renal failure, 307 extra patients with cataracts, and 39 extra patients with myopathy. Similar figures were found for men except rates of myopathy were higher. Some of the effects might be due to better detection rates since patients taking statins will consult their doctor more.

The authors said: “At national level, our study is likely to be useful for policy and planning purposes. Our study may also be useful for informing guidelines on the type and dose of statins.”

A companion paper by the same researchers, published today in the journal Heart, shows that their newly-developed and validated risk prediction algorithms could be used to identify patients at high risk of adverse events from statins so that they can be monitored more closely.

A web calculator suitable for use by doctors can be found at

http://www.qintervention.org

In an accompanying editorial, two senior cardiologists say that, like any intervention in medicine, statins are not entirely free of adverse events, but that when used according to current guidelines, the benefits outweigh the risks.

The BMJ report of this research is available free here:

Unintended effects of statins

A free PDF of the companion paper is here:

Individualizing the risks of statins

MSU.edu - Older patients battling pneumonia spent less time in the hospital when treated using osteopathic manipulative medicine - a drug-free form of hands-on medical care focusing on increasing muscle motion - in addition to conventional care, recently published research shows.

Kari Hortos, a Michigan State University professor in the College of Osteopathic Medicine’s Department of Internal Medicine, was one of seven site investigators as part of the five-state Multicenter Osteopathic Pneumonia Study in the Elderly.

The study revealed patients being treated additionally with osteopathic manipulative medicine stayed in the hospital one day less compared to patients receiving conventional care only.

“The results suggest a role for osteopathic manipulative medicine to support conventional therapy in the treatment of pneumonia, which is the fourth most common hospital diagnosis in the country,” Hortos said. “Besides the obvious benefit of getting people home quicker, the cost savings could be enormous. Further study is needed with these treatments.”

The randomized, controlled clinical trial worked with seven hospitals to assess the impact of osteopathic manipulative treatment in patients 50 and older. The study, done between March 2004 and February 2007, was recently published in the journal Osteopathic Medicine and Primary Care.

In addition to the reduced length of hospital stay, manipulative medicine also showed a slight decrease in both the amount of intravenous antibiotics needed and respiratory failure, according to the study findings.

Osteopathic manipulative treatments have been used throughout the United States since the late 1800s. The techniques can be used to alleviate pain, restore range of motion and enhance the immune system.

Another form of treatment called light touch - a light form of massage - also was used as a comparative group in the MOPSE study; while patients receiving it did respond favorably, the results were not as significant as for those receiving osteopathic treatments in addition to conventional care.

Hortos said the fact even light-touch treatments showed some benefit emphasizes the possible role human touch may play in helping patients heal.

“Human contact, both from a physical and emotional aspect, seems to help patients heal faster,” she said.

Individuals who have poor oral hygiene have an increased risk of heart disease compared to those who brush their teeth twice a day, finds research published by the British Medical Journal.

In the last twenty years there has been increased interest in links between heart problems and gum disease. While it has been established that inflammation in the body (including mouth and gums) plays an important role in the build up of clogged arteries, this is the first study to investigate whether the number of times individuals brush their teeth has any bearing on the risk of developing heart disease, says the research.

The authors, led by Professor Richard Watt from University College London, analyzed data from over 11,000 adults who took part in the Scottish Healthy Survey.

The research team analyzed data about lifestyle behaviors such as smoking, physical activity and oral health routines. Individuals were asked how often they visited the dentist (at least once every six months, every one to two years, or rarely/never) and how often they brushed their teeth (twice a day, once a day or less than once a day).

On a separate visit nurses collected information on medical history and family history of heart disease, blood pressure and blood samples from consenting adults. The samples enabled the researchers to determine levels of inflammation that were present in the body. The data gathered from the interviews were linked to hospital admissions and deaths in Scotland until December 2007.

The results demonstrate that oral health behaviors were generally good with six out of ten (62 percent) of participants saying they visit the dentist every six months and seven out ten (71 percent) reporting that they brush their teeth twice a day.

Once the data were adjusted for established cardiovascular risk factors such as social class, obesity, smoking and family history of heart disease, the researchers found that participants who reported less frequent toothbrushing had a 70 percent extra risk of heart disease compared to individuals who brushed their teeth twice a day, although the overall risk remained quite low. Participants who had poor oral hygiene also tested positive for inflammatory markers such as C-reactive protein and fibrinogen.

Professor Watt concluded: “Our results confirmed and further strengthened the suggested association between oral hygiene and the risk of cardiovascular disease - furthermore inflammatory markers were significantly associated with a very simple measure of poor oral health behaviour”. He adds that “future experimental studies will be needed to confirm whether the observed association between oral health behaviour and cardiovascular disease is in fact causal or merely a risk marker” (Courtesy of EurekAlert!, a service of AAAS).