Pointy Nose, Snub Nose? These Genes May Decide

THURSDAY, May 19, 2016 (HealthDay News) — Whether you love or hate your nose, you have certain genes to thank for its distinctive look, a new British study finds.

“What we’ve found are specific genes which influence the shape and size of individual features, which hasn’t been seen before,” said study lead author Kaustubh Adhikari, a developmental biologist at University College London.

His team analyzed about 6,000 people in Brazil, Chile, Colombia, Mexico and Peru. All had mixed ancestry — European (50 percent), Native American (45 percent) and African (5 percent) — providing a large variation in facial features.

The researchers pinpointed four genes that affect the width and pointiness of the nose, as well as another gene that influences chin protrusion.

“Few studies have looked at how normal facial features develop, and those that have only looked at European populations, which show less diversity than the group we studied,” Adhikari said in a college news release.

The findings could improve understanding of how the human face evolved, the researchers suggested. It may also prove useful in forensic DNA technologies that create a person’s face based on their genetic makeup, the investigators said.

“Finding out the role each gene plays helps us to piece together the evolutionary path from Neanderthal to modern humans. It brings us closer to understanding how genes influence the way we look, which is important for forensics applications,” Adhikari explained.

The nose aids in regulating the humidity and temperature of the air humans breathe. Experts have long suspected that the shape of the nose may change based on the environment where humans lived and evolved.

“For example, the comparatively narrower nose of Europeans has been proposed to represent an adaptation to a cold, dry climate,” said study co-author Andres Ruiz-Linares, biosciences professor at University College London.

“Identifying genes affecting nose shape provides us with new tools to examine this question, as well as the evolution of the face in other species. It may also help us understand what goes wrong in genetic disorders involving facial abnormalities,” Ruiz-Linares added.

The study was published May 19 in the journal Nature Communications.

More information

The American Academy of Otolaryngology — Head and Neck Surgery has more about the nose.

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A Little Excess Weight May Boost Colon Cancer Survival

THURSDAY, May 19, 2016 (HealthDay News) — In what may come as a bit of a surprise, a new study found that overweight colon cancer patients tended to have better survival than their normal-weight peers.

“Overweight and obesity have been identified as risk factors for many health conditions, but for people with colorectal cancer, some extra weight may provide protection against mortality,” said study lead author Candyce Kroenke. She’s a research scientist at Kaiser Permanente Division of Research in Oakland, Calif.

Still, one health expert cautioned that the finding is no license for people to pile on excess pounds.

“This study should not be used to describe an ‘upside’ of being overweight with regard to cancer risk, since overweight people develop cancer at higher rates,” said gastroenterologist Dr. Arun Swaminath of Lenox Hill Hospital in New York City.

In the study, Kroenke’s team examined the medical records of more than 3,400 people in California diagnosed with stages 1-3 colon cancer between 2006 and 2011. The researchers then compared each patient’s risk of death at the time of diagnosis and then over the following 15 months.

Patients who were either underweight or statistically obese at diagnosis were more likely to die than normal-weight patients, the study found.

However, people who fell into the “overweight” — but not obese — category were 55 percent less likely to die from colon cancer and 48 percent less likely to die from any cause than normal-weight patients, the research team found.

Prior research has shown that overweight and obese people are at higher risk for several types of cancers. However, they often have better cancer outcomes than normal-weight patients, something referred to as the “obesity paradox,” the researchers noted.

“Our study, which represents the largest cohort of colorectal cancer patients with the most comprehensive data regarding patient weight before, at time of, and following diagnosis, supports the notion of the ‘obesity paradox,’ ” Kroenke said in a Kaiser news release.

This is an observational study, however, so it cannot prove that weight helped cause (or shield against) death in these patients.

Also, the study “doesn’t explain why this is true,” noted Swaminath, who directs the inflammatory bowel disease program at Lenox Hill.

Another expert said the information is important, but shouldn’t be overgeneralized.

“I feel that this study reinforces the fact that colorectal cancer treatment needs to be individualized for each patient,” said Dr. Jules Garbus, a colorectal surgeon at Winthrop-University Hospital, in Mineola, N.Y.

“However, it should be said that practitioners must exercise caution when discussing any ‘benefits’ of overweight with patients, as there is much stronger data to support the dangers of obesity on overall health and well-being,” he said.

The study was published May 19 in the journal JAMA Oncology.

More information

The American Cancer Society has more about colon cancer.

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B12 Shots: Should You Get One?

Photo: Getty Images

More and more, ours is a worn out, sleep-deprived, distracted nation. It’s no wonder a shot of energy and focus would appeal to many of us. And that’s exactly what B12 injections deliver—literally—for those who lack sufficient stores of the nutrient.

“B vitamins are essential for proper cellular respiration,” explains Dr. Roxanne Sukol, medical director of Cleveland Clinic’s Wellness Enterprise. Without adequate supplies of B12, most of the cells in your body will struggle to take in enough oxygen, which can affect everything from your energy levels to your mood and concentration, Sukol says. Classic symptoms of a B12 deficiency also include diarrhea or constipation, pale skin, and shortness of breath, according to the National Institutes of Health.

The nutritional necessity of B12 explains why it’s such a popular supplement, and also why some celebrities have touted B12 injections as the magic ingredient in their health regimens. The vitamin’s links to increased energy have also made B12 popular among some dieters and weight loss clinics—the thinking being that more energy will translate to more exercise.

“But unless you have a B12 deficiency, there’s really no role for it,” Sukol says of B12 shots and supplements. Put simply, more isn’t better. And even if you’re low on B12, there’s no evidence injections of it will help you lose weight, says Dr. Brent Bauer, director of the complementary and integrative medicine program at Mayo Clinic. “Everybody’s looking for a shortcut,” he says. “B12 supplementation has its benefits, but it’s not a solution for weight loss.”

So weight loss is out, but B12 shots have been associated with other conditions, too. In fact, there’s some solid research on B12 injections for the treatment of fibromyalgia and myalgia encephalomyelitis.

Food sources of the vitamin include eggs, meat, and dairy products. People who eschew those foods are at elevated risk. “When I test vegans for B12, they’re usually on the low side—if not deficient,” Sukol says. Some gut-related diseases like Crohn’s or Celiac—as well as most types of weight loss surgery—can also limit the amount of B12 your system absorbs, she adds.

But figuring out if you’re low on B12 is trickier than you might suppose. A much-cited 2000 study from the American Journal of Clinical Nutritionfound nearly 40% of the population have B12 levels that fall at or below what experts consider the low end of normal. While you might assume anything in the “normal” range means you’re in good shape, Sukol says that’s not always the case.

“Blood tests are not always black and white the way we’d like them to be,” she says. “If I have a patient taking a lot of naps and complaining about poor concentration, I might recommend B12 supplementation even though the blood tests look normal.”

You’ll notice she says “supplementation” and not “injections.” Unless you have one of the above conditions that prevent your gut from breaking down and absorbing the vitamin, a B12 pill is as effective as a B12 poke, research suggests. Sukol agrees. “For many people, an oral supplement is just as good [as an injection].”

Finally, when it comes to the safety of both B12 injections and oral supplements, you don’t have much to worry about. “B12 is water soluble, and it’s generally safe even at very high doses,” Bauer explains. “You put a needle in your arm and there’s always the risk of swelling or pain at the site, but in the complementary medicine realm B12 is probably one of the safest things you could take.”

If you’re often worn out or foggy brained, even after a good night’s sleep, “take a B12 supplement for a week or two and see how you feel,” Sukol advises. If your fatigue persists, have your blood tested for nutrient deficiencies.

A B12 shot may be just what your doctor orders.

This article originally appeared on Time.com.

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Fatty Foods During Teen Years May Influence Later Breast Cancer Risk

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 19, 2016 (HealthDay News) — Teens who eat high amounts of saturated fats or low amounts of healthier mono- and polyunsaturated fats tend to have denser breasts 15 years later, new research suggests.

That’s important because greater breast density is a risk factor for breast cancer, the study authors said.

But the researchers noted they didn’t find a large change in breast density volume based on dietary fat intake.

“It was a modest difference in breast density,” said the study’s senior author Joanne Dorgan. She’s a professor of epidemiology at the University of Maryland School of Medicine in Baltimore.

While this study can’t prove cause-and-effect, the researchers speculated that different fats may play different roles in breast tissue formation and maintenance. Teen years are a critical time for breast development, the study authors noted.

Dorgan and her team reviewed data from the Dietary Intervention Study in Children. This clinical trial, sponsored by the U.S. National Heart, Lung, and Blood Institute, started in 1988, enrolling more than 600 children between ages 8 and 10. More than 300 of the children were girls.

On multiple occasions, the participants reported details of their diets. Later, in a follow-up of the same group, the researchers used MRI scans to measure breast density in 177 female participants when they were ages 25 to 29.

The researchers found that higher intakes of unhealthy fats and lower intake of healthy fats during adolescence were associated with an increased risk of denser breasts. Experts and organizations such as the American Heart Association (AHA) recommend that a healthy diet should contain about 5 percent saturated fat.

Saturated fats come from beef, lamb, pork, poultry with skin, butter, cream, cheese and other whole or 2 percent dairy products, the AHA says. Polyunsaturated and monounsaturated fats are found in fatty fish, avocados, walnuts, olives and liquid vegetable oils, the AHA notes.

Women who ate the most saturated fat during adolescence got about 13 percent of total calories from saturated fat. These women had an average breast density of 21.5 percent, the study found. Women who ate the least saturated fat — about 8 percent of total calories from fat — had a breast density of 16.4 percent.

A similar difference was found for those who ate the lowest levels of healthy fats during the teen years compared to those who ate the highest levels. Eating more healthy fats was linked with less breast density, the study said.

Dr. Laura Kruper, co-director of the breast cancer program at the City of Hope Cancer Center, in Duarte, Calif., reviewed the findings. She noted that the study had some limitations, including relying on self-reports of diet and a relatively small number of study participants.

“It is not known whether breast density measured at 25 to 29 will persist into the 40s and 50s, when the risk of breast cancer begins to increase,” she said.

If the correlation holds up, Kruper said, “it would potentially have implications regarding dietary recommendations for adolescents.” But more study is needed, she said.

Study author Dorgan said, “This is an initial study; it would need to be confirmed before making any recommendation [about diet].”

The study appears in the June issue of the journal Cancer Epidemiology, Biomarkers & Prevention.

More information

To learn more about breast density, visit American College of Radiology.

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States With More Gun Owners Have More Gun-Related Suicides: Study

By Amy Norton
HealthDay Reporter

THURSDAY, May 19, 2016 (HealthDay News) — In states where there are more gun owners, there are also more gun-related suicides, a new U.S. study finds.

Looking at 33 years’ worth of data, the researchers found that states with more gun owners generally had more suicides by firearm among both men and women. Men in those states also had higher overall suicide rates.

The findings do not prove that guns lead to more suicides, said lead researcher Dr. Michael Siegel, a professor at the Boston University School of Public Health.

However, his team considered many other factors that could affect a state’s suicide patterns — including unemployment levels, divorce rates, crime and residents’ typical alcohol intake.

And still, suicide rates rose in tandem with gun ownership, Siegel noted. For every 10-percentage-point increase in a state’s gun ownership level, the rate of gun-related suicides among men rose by 3 per 100,000 people.

Among women, the increase was 0.4 per 100,000, the study found.

Siegel said it’s “unlikely” that some other, unmeasured factor would explain the association.

He and his colleague reported the findings online May 19 in the American Journal of Public Health.

Other studies have found that states with more gun owners tend to have more homicides by firearm. “But the argument there is, it could be a case of ‘reverse causation,’ ” Siegel explained. That is, people who live in places with gun violence may be more likely to buy a gun to protect themselves.

With suicide rates, “it’s unlikely that people living in areas with more suicides are going to decide to buy a gun,” he said.

It’s still possible there are additional reasons for the link seen in this study, according to Daniel Webster, director of the Center for Gun Policy and Research at Johns Hopkins University, in Baltimore.

Depression is the major driver of suicide, and there was no measure of the prevalence of depression across states, Webster pointed out.

Then there are the intangibles. “People who own guns may be of the mind that they’ll take care of themselves,” Webster said. “They might be less willing to seek treatment for depression.”

That said, he doubted that those unmeasured factors would account for the findings. “The association is so strong, those [other factors] would have to be very powerful,” Webster said.

For the study, Siegel’s team used government statistics on suicide rates in all 50 states between 1981 and 2013. The researchers had to estimate each state’s gun ownership level — using hunting license rates, for example — since there were no state-level statistics kept for most of the study period.

Over those 33 years, men had a much higher rate of gun-related suicide than women: Nationally, the rate among men was 14 per 100,000, versus 2 per 100,000 among women, according to the report.

But those rates varied widely among states, and generally fell in line with gun ownership levels, the findings showed. Massachusetts had the second-lowest percentage of gun owners (at an estimated 14 percent) and the lowest firearm-suicide rate among men (at 4 per 100,000).

Wyoming, the state with the most gun owners, also had the highest rate of gun-related suicide among men — at 26 per 100,000. And the rate among women — nearly 4 per 100,000 — was among the highest nationally.

Men in states with more gun owners also typically had a higher overall suicide rate, the investigators found. That was not the case with women, however.

Siegel and Webster both pointed to the same potential explanation: In general, “impulsivity” is a bigger factor in men’s suicides. If they have no immediate access to a highly lethal means, that might buy the time they need to reconsider.

Women tend to be different, Siegel explained. When they’re suicidal, they typically make a plan. So the availability of a gun, he said, may not change the likelihood of a woman taking her own life — but may change the means.

To Siegel, the findings highlight a point that is often missing in debates over gun control.

“The debate usually focuses on homicide,” he said. “Some people argue that more guns in the hands of law-abiding citizens will help prevent homicides.”

But those same law-abiding citizens can become depressed and suicidal. “If we add the issue of suicide to the debate,” Siegel said, “that changes the equation.”

There already is evidence that gun policies can affect suicide rates, Webster said.

One of his own studies found that teen suicide rates dipped in states that passed laws that mandate safe storage of firearms.

More information

The American Psychological Association has more on preventing gun violence.

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There’s Actually a ‘Smart’ Tampon In the Works

Photo: Getty Images

In a day and age where there’s a smart device for absolutely everything, we should have known this one was coming. Behold the ‘smart’ tampon – it will actually alert you when it’s getting too full and needs a change pronto.

RELATED: The 5 Best Subscriptions Boxes For That Time of the Month

How the heck could this thing work? Let us explain: The string of the tampon is equipped with Bluetooth technology. The packaging apparently comes with a little button that you place somewhere on your being, then you download the corresponding app to your smartphone so that it can set the whole thing into action. When the tampon’s maximum capacity is being reached, the app will alert you to give it a change ASAP. It will also indicate how full it is. My guess is even Judy Jetson never imagined this kind of technology could actually become a thing.

The idea comes from startup My.Flow and right now they’re looking for funding.

RELATED: Yes, a Store Specifically For Your Period Exists

It sounds like this would be most beneficial to women who endure seriously heave periods and could be a miracle find for anyone who finds themselves in embarrassing leakage situations every months. We’re just curious as to how much a “smart” tampon could cost. Feminine products are already expensive in the sense that we need them, so hopefully My.Flow can figure out a way to keep their price point on par with other brands while delivering this service which many women need.

This article originally appeared on InStyle.com/MIMI.

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FDA Approves New Drug to Treat Bladder Cancer

THURSDAY, May 19, 2016 (HealthDay News) — A new drug to treat bladder cancer was approved by the U.S. Food and Drug Administration on Wednesday.

Tecentriq (atezolizumab) treats the most common type of bladder cancer, called urothelial carcinoma. It’s the first in its class of drugs, called PD-1/PD-L1 inhibitors, approved to treat this type of cancer.

“Tecentriq provides these patients with a new therapy targeting the PD-L1 pathway,” Dr. Richard Pazdur, director of the office of hematology and oncology products in the FDA’s Center for Drug Evaluation and Research, said in an agency news release.

“Products that block PD-1/PD-L1 interactions are part of an evolving story about the relationship between the body’s immune system and its interaction with cancer cells,” he added.

The FDA approved Tecentriq for treatment of patients with locally advanced or metastatic urothelial carcinoma whose disease has worsened during or following platinum-containing chemotherapy, or within 12 months of receiving platinum-containing chemotherapy, either before or after surgery.

Urothelial carcinoma occurs in the urinary tract system, involving the bladder and related organs. An estimated 76,960 new cases of bladder cancer and 16,390 deaths from the disease will occur in the United States in 2016, according to the U.S. National Cancer Institute.

The FDA’s approval of Tecentriq is based on a clinical trial involving 310 patients with locally advanced or metastatic urothelial carcinoma. Nearly 15 percent of patients had at least partial shrinkage of their tumors, which lasted from about 2 months to nearly 14 months at the time the data was analyzed, the study found.

Tumor response occurred in 26 percent of patients who were positive for PD-L1 expression, compared with 9.5 percent of those who were negative for PD-L1 expression, the findings showed. This suggests that patients who are positive for PD-L1 expression may be more likely to respond to treatment with Tecentriq.

Therefore, the FDA also approved a companion test to detect PD-L1 protein expression levels in patients, to help doctors identify those most likely to benefit from Tecentriq.

During the clinical trial, common side effects associated with Tecentriq were fatigue, decreased appetite, nausea, urinary tract infection, fever and constipation. The drug also has the potential to cause infection and serious immune system side effects involving healthy organs such as the lungs, colon and endocrine system, the FDA said.

Tecentriq is made by San Francisco-based Genentech.

More information

The American Cancer Society has more about bladder cancer.

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Family Rejection Triples Risk for Suicide Attempts by Transgender People: Study

THURSDAY, May 19, 2016 (HealthDay News) — Transgender people can face big difficulties, but a new study shows their journey is made much harder when family members reject them.

The researchers found that risks for attempting suicide more than tripled for transgender adults who experienced a “high level” of familial rejection. The risk for alcohol or drug abuse also rose much higher in these situations, the research found.

Why is the potential rejection of parents, spouses and children so devastating? As researchers from the City University of New York explained, when transgender individuals face societal stigma, families can provide crucial support.

However, when their families shut them out, this may deprive transgender people of a much-needed emotional “buffer” against that discrimination, wrote co-authors Augustus Klein and Sarit Golub.

One expert agreed that the support of loved ones is key.

“This important study demonstrates what clinicians have seen in their offices — that those individuals who are rejected by their families often self-medicate with substances to cope, and are frequently hopeless and become suicidal,” said Dr. Victor Fornari. He directs child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y.

According to the authors, the new study is the largest ever conducted on this issue. Golub and Klein looked at 2008-2009 data on almost 3,500 transgender adults interviewed from all 50 states, as part of the National Transgender Discrimination Survey.

“The sample was largely white, well-educated and employed,” the team noted.

There was some good news: More than half (about 54 percent) said they had experienced little or no family rejection, the authors said.

But close to a third (31 percent) experienced “moderate” family rejection, while more than 14 percent faced a “high” level of this type of rejection.

“High” family rejection meant that the person had experienced rejection in multiple ways. For example, a spouse left them and/or prevented contact with their child; there were incidents of domestic violence; children cut off communication; or parents or siblings stopped communicating with the person.

In the case of “high” level rejection, the odds that the transgender person might attempt suicide rose by almost three and a half times, compared to people without such rejection, the study found.

A high level of family rejection was tied to a two and a half times higher risk for substance abuse, the research showed.

Even a “moderate” level of family rejection caused the risks for suicide or substance abuse to climb considerably, the CUNY researchers noted.

Overall, rates of suicide attempts and substance abuse were not rare among those surveyed. More than 42 percent of all respondents said they had attempted suicide, while about 26 percent “reported misusing alcohol or drugs to cope with transgender discrimination,” the researchers wrote.

None of this was a surprise to Fornari.

“Gender nonconforming individuals frequently experience family criticism and rejection,” Fornari noted. He believes that educating and supporting the families of transgender individuals is crucial. That means helping family members deal with the situation, “in a way that does not prevent them from accepting their loved one for who they are,” he said.

Dr. Robert Dicker is associate director of the division of child and adolescent psychiatry at Northwell Health in New Hyde Park, N.Y. He believes the new findings call for, “developing interventions aimed at mitigating family rejection and strengthening family bonds,” for transgender individuals.

The study was published online May 16 in LGBT Health.

More information

To read more about transgender issues, visit GLAAD.

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‘Precision’ Cancer Treatment May Extend Lives

By Dennis Thompson
HealthDay Reporter

THURSDAY, May 19, 2016 (HealthDay News) — “Precision” cancer treatment that’s guided by genetic clues from the patient’s own tumor appears to outperform traditional chemotherapy, a new research review finds.

Patients given precision — or personalized — treatment experienced a tumor shrinkage rate six times that attained by regular chemotherapy. But, that only happened if doctors used genetic information to choose the appropriate targeted therapy, said lead researcher Maria Schwaederle.

Those patients also experienced nearly double the length of time before their cancer resumed growing, according to the analysis of nearly 350 clinical trials.

“It is not just that the therapies are better, but that targeted therapies must be given to the right patients,” said Schwaederle, who’s with the University of California, San Diego School of Medicine’s Center for Personalized Cancer Therapy.

She will present these results at the American Society of Clinical Oncology’s annual meeting in Chicago next month. But until they’re published in a peer-reviewed medical journal, data and conclusions presented at meetings are usually considered preliminary.

Precision medicine aims to treat cancer by targeting the unique DNA mutations that allow tumors to grow and spread, according to the U.S. National Cancer Institute.

Drugs developed under this approach might help the immune system better find and destroy cancer cells; block cancer-cell division; stop signals that form new tumor-feeding blood vessels; or order the cancer cells to commit suicide, the cancer institute says.

This new study shows the potential power of precision medicine, if a specific drug is available to treat a specific cancer, said Dr. David Hyman, a medical oncologist and director of developmental therapeutics at Memorial Sloan Kettering Cancer Center in New York City.

“To me, these results are not at all surprising,” Hyman said. “If you put a patient with the right mutation on the right drug, they do better than if you put them on a drug that has nothing to do with their tumor.”

Examples of targeted therapies include the lung cancer drug erlotinib (Tarceva), the melanoma drug dabrafenib (Tafinlar), and the breast cancer drug trastuzumab (Herceptin). All inhibit cancer by interfering with the signals that spur tumor growth, Hyman said.

In this study, Schwaederle and her colleagues analyzed 346 phase 1 clinical trials published between 2011 and 2013. All told, the trials involved more than 13,200 patients.

Those trials included 58 treatment arms that employed precision medicine, using tumor data to select patients for treatment, and 293 that did not.

Treatment arms employing precision medicine achieved tumor shrinkage rates of about 31 percent, compared to about 5 percent in those that did not match a person’s cancer to the drug being tested, the study found.

Patients in precision medicine arms also had nearly twice the progression-free survival — time spent on medication before their cancer resumed progression — with an average of 5.7 months compared with 2.9 months.

Researchers also found that basing therapy on a patient’s DNA indicators outperformed use of protein indicators, 42 percent to 22.4 percent.

“If we select patients that have the anomaly that is targeted by the drug, it is pretty intuitive that we can observe better response rates,” Schwaederle said.

Phase 1 trials are generally considered a basic first step that determines whether a drug is safe to take. But these study findings suggest that cancer patients might receive lifesaving treatment if researchers take the time to analyze their cancer beforehand, Hyman said.

Because these results occurred in phase 1 trials, they show that it’s never too soon to use genetic information to match a patient to the right drug, Hyman said.

Previous analyses of phase 2 and phase 3 trials by the same team also found improved outcomes with precision medicine, and the researchers argued that such benefits can be had during phase 1 trials as well.

“If we’re not making that effort, then we’re not doing the best we can do” for patients participating in early clinical trials, Hyman said.

More information

For more on precision cancer treatment, visit the U.S. National Cancer Institute.

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Thousands of Public Pools, Hot Tubs Closed for Dirty Water: CDC

By Dennis Thompson
HealthDay Reporter

THURSDAY, May 19, 2016 (HealthDay News) — Folks flocking to swimming pools to beat the summer heat might be dipping their toes into poorly treated water, U.S. health officials warned Thursday.

Serious health and safety violations force the closure of thousands of public pools, hot tubs and water playgrounds every year, according to a new study by the U.S. Centers for Disease Control and Prevention.

“We have a long way to go here to lower the number of public aquatic venues with serious health and safety violations,” said Michael Beach, the CDC’s associate director for healthy water. “We need to protect the public.”

A review of inspection reports from the five states containing 40 percent of the nation’s public aquatic venues found that:

• Nearly 80 percent of inspections found at least one violation.
• One in eight inspections prompted immediate closure due to serious health and safety violations.
• Kiddie and wading pools had the most problems, with one in five shut down due to violations.

“Young children who are still learning their toileting skills are more likely to contaminate the water. They’re more likely to swallow the water. Both of which can lead to outbreaks of diarrheal illness,” Beach said.

Pool facilities were cited most often for improper pH (15 percent), lack of proper safety equipment (13 percent) and inadequate disinfectant levels (12 percent).

Beach said that “pH is critical here because it determines how effective the disinfectant is at killing germs.”

Most contamination of public pools and hot tubs results from people swimming while suffering from diarrhea, Beach said.

“Somebody who is ill with diarrhea has a release in the pool, and then it’s a very common occurrence to swallow pool water while you’re swimming,” he said.

Parents can help keep a pool clean by checking diapers and taking kids out for a bathroom break once every hour. Diapers should be changed in a bathroom or changing area, not poolside, the CDC recommends.

Adults should not swim while recovering from a bout of diarrhea, and shower before they get in the water.

One-quarter of treated pool diarrhea outbreaks are associated with bacteria like Shigella, Campylobacter and E. coli that ought to have been eliminated by pool disinfectants, Beach said.

“That’s about very poor pool operation,” he said. “You don’t have chlorine. Your pH is way off.”

The other three-quarters of pool diarrheal outbreaks are related to cryptosporidiosis, a disease caused by a parasite that is “resistant or very tolerant to chlorine, so it kind of evades that main barrier we have in pools,” Beach said.

The CDC’s new Model Aquatic Health Code recommends that public pools install secondary disinfection systems to fend off the Cryptosporidium parasite, he said.

Pool-goers also can suffer eye and respiratory tract irritation due to volatile disinfection by-products called chloramines, which form when pool chlorine interacts with human waste products like sweat or urine. The largest such event occurred in Ohio in 2007, affecting at least 665 people, according to the CDC report.

“We have to do a better job at safeguarding pools and all water facilities to prevent outbreaks of diarrhea, skin and soft tissue infections, and other communicable diseases,” said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.

For the report, CDC researchers collected 2013 inspection data from Arizona, California, Florida, New York and Texas, which combined represent nearly 40 percent of the nation’s public pools, hot tubs and water playgrounds. The data covered over 84,000 routine inspections of nearly 49,000 public places where people swim in treated water.

Two-thirds of the inspections involved public pools, and about 12 percent resulted in immediate closure due to health or safety violations.

About one-quarter of the inspections were for public hot tubs or spas, and 15 percent resulted in immediate closure, the report said.

The CDC encourages people to test the water themselves before diving in, using pool test strips available at most superstores or pool supply stores.

With Healthy and Safe Swimming Week beginning May 23, the CDC says properly sanitized water should have a:

• free chlorine concentration of at least 1 ppm in pools and at least 3 ppm in hot tubs/spas.
• free bromine concentration of at least 3 ppm in pools and at least 4 ppm in hot tubs/spas.
• pH value between 7.2 and 7.8.

Swimmers should also make sure that the water is clear enough to see the bottom of the deep end, check that drain covers are secured and in good repair, and make sure that a lifeguard or safety equipment are on hand.

If there are problems, don’t get in the water, Beach said. Instead, tell someone in charge so the problems can be addressed.

The new report was published in the May 20 issue of the CDC’s Morbidity and Mortality Weekly Report.

More information

For more healthy swimming tips, visit the U.S. Centers for Disease Control and Prevention.

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