The New Nation - Internet Edition

Bottled water : Is it safe?

Easir Abedin

Over the past two decades, people have increasingly been shifting to bottled water because they consider it safe; find it refreshing, calorie-free, convenient to carry around, tastier than some tap water and healthier than soft drinks. But more and more people are questioning whether the water, and the package it comes in, is safe, or at least safer than tap water -- and if the convenience is worth the environmental impact.

Bottled water products can be traced back to the Romans who were aware of health benefits associated with certain waters. There is a legend that Hannibal, the famous Roman general rested his troops at Les Bouillens in France, the location of the Perrier drinking water spring. Over the years. the importance of certain sources continued to rise.

By the eighteenth century, the doctors were touting the beneficial effects of bathing, showering and drinking natural mineral water. Incidentally, the spa movement that began in Europe had its origins in baths dating from Roman times. Cold spa waters were bottled for the first time in France in the 1850s.

Most people have bottled water because they consider bottled water safer than tap water.

1. It is portable and easy to carry.

2. It is refreshing

3. It is considered good for health.

Tap water may be contaminated by a range of chemical, microbial and physical hazards that could pose risks to health if they are present at high levels. Examples of chemical hazards include lead, arsenic and benzene. Microbial hazards, include bacteria, viruses and parasites, such as Vibrio cholerae, hepatitis A virus, and Crytosporidium parvum, respectively. Physical hazards include glass chips and metal fragments. Because of the large number of possible hazards in drinking-water, the development of standards for drinking-water requires significant resources and expertise, which many countries are unable to afford.

The US- FDA (Food and Drug Administration) also classifies some bottled water according to its origin.

·Artesian well water. Water from a well that taps an aquifer--layers of porous rock, sand and earth that contain water--which is under pressure from surrounding upper layers of rock or clay. When tapped, the pressure in the aquifer, commonly called artesian pressure, pushes the water above the level of the aquifer, sometimes to the surface. Other means may be used to help bring the water to the surface.

According to the EPA, water from artesian aquifers often is more pure because the confining layers of rock and clay impede the movement of contamination. However, despite the claims of some bottlers, there is no guarantee that artesian waters are any cleaner than ground water from an unconfined aquifer, the EPA says.

·Mineral water. Water from an underground source that contains at least 250 parts per million total dissolved solids. Minerals and trace elements must come from the source of the underground water. They cannot be added later.

· Spring water. Derived from an underground formation from which water flows naturally to the earth's surface. Spring water must be collected only at the spring or through a borehole tapping the underground formation feeding the spring. If some external force is used to collect the water through a borehole, the water must have the same composition and quality as the water that naturally flows to the surface.

· Well water. Water from a hole bored or drilled into the ground, which taps into an aquifer.

Bottled water may be used as an ingredient in beverages, such as diluted juices or flavored bottled waters. However, beverages labeled as containing "sparkling water," "seltzer water," "soda water," "tonic water," or "club soda" are not included as bottled water under the FDA's regulations, because these beverages have historically been considered soft drinks.

Some bottled water also comes from municipal sources--in other words--the tap. Municipal water is usually treated before it is bottled.

Examples of water treatments include:

·Distillation. In this process, water is turned into a vapor. Since minerals are too heavy to vaporize, they are left behind, and the vapors are condensed into water again.

·Reverse osmosis. Water is forced through membranes to remove minerals in the water.

·Absolute 1 micron filtration. Water flows through filters that remove particles larger than one micron in size, such as Cryptosporidium, a parasitic protozoan.

·Ozonation. Bottlers of all types of waters typically use ozone gas, an antimicrobial agent, to disinfect the water instead of chlorine, since chlorine can leave residual taste and odor to the water.

Tap water vs bottled water -- There is a common belief that botted water is better than tap waster. Though it might be true in developing countries, it is not the case in many developed countries. A four-year survey of the bottled water industry conducted by Natural Resources Defense Council (NRDC) in Canada revealed that one-third of the bottled water tested contained levels of contamination which exceeded allowable limits under either state or bottled water industry standards or guidelines. The survey also observed that an estimated 25 percent or more of bottled water was just tap water in a bottle --sometimes further treated, sometimes not.

Know your water -- To determine bottled water is really just tap water, check if the bottle label or the cap says "from a municipal source" or "from a community water system".

To improve safety of bottled water

*Initiatives should be taken by citizens to urge their concerned governments to adopt strict requirements for bottled water safety, labeling, and public disclosure. Citizens should specifically request for -

*Setting of strict limits for contaminants of concern in bottled water, including arsenic, heterotrophic-plate-count bacteria, E. coli and other parasites and pathogens, and synthetic organic chemicals such as "phthalates".

*Ensuring the application of rules to all types of bottled water -- including carbonated water and those sold intrastate or interstate

*Setting regulations that require bottlers to display information on their labels about the levels of contaminants of concern found in the water, the water's exact source, how it has been treated, and whether it meets health criteria set by the concerned environmental protection agency and the disease control agency for killing parasites like cryptosporidium.

Some substances may prove more difficult to manage in bottled than tap water. This is generally because bottled water is stored for longer periods and at higher temperatures than water distributed in piped distribution systems. Control of materials used in containers and closures for bottled waters is, therefore, of special concern. In addition, some micro-organisms, which are normally of little or no public health significance, may grow to higher levels in bottled waters. This growth appears to occur less frequently in gasified water and in water bottled in glass containers compared to still water and water bottled in plastic containers. There have also been reports of fraud in which ordinary tap water has been added to used mineral water bottles and sold as the original article. Consumers may not be able to detect this by taste alone and, if concern is warranted, should examine the closures of bottled waters carefully before purchase and insist on seeing bottles opened in their presence in restaurants and other food and beverage service establishments.

Water it's another name is Life. In a recent study shows that about 70% disease occur (Like Diarrhoea,Dysentery, Typhoid Fever, Jaundice, Amebic dysentery,cholera e.t.c) as waterborne in Dhaka city. The World Health Organization says that every year more than 3.4 million people die as a result of water related diseases, making it the leading cause of disease and death around the world. So the Bottle water manufacturing company in Bangladesh should consider the quality of the Bottle water according to WHO guideline or EPA Guideline to make good health safety of the public.

(The writer is an Assistant Manager, Quality Control at NOVO Healthcare and Pharma Ltd.)

Usefulness of dental implant

Dr. Md. Al-amin bhuiyan

A dental implant is nothing more than a metal screw that is placed into the jaw bone. It acts as an anchor for a false tooth or a set of false teeth. The slide to the left shows the replacement of a lateral incisor with a dental implant retained restoration.

Anyone in reasonable health who wants to replace missing tooth or teeth. You must have enough bone in the area of the missing teeth to provide for the anchorage of the implants. Some people are missing all their teeth and most of those are excellent candidates for dental implants, but today, we use implants to replace small bridges, removable partial dentures and even missing single teeth.

This depends very much on where the implants are placed and what they will be called upon to do. The best case scenario is the placement of implants in the front portion of the lower jaw. Here success can be as high as 98-100%. In other areas of the mouth, success rates can drop significantly. According to figures that we have today, the success of implants in the front part of the upper jaw are anywhere from 90-95%. Success rates of implants in the back part of the upper and lower jaw can be in the 85-95% range. The success rate in my practice for the past five years has been 99+% for all implants placed.

There are really not too many things that can go wrong with dental implants. They can fail to integrate into the bone and come out. They can fracture or break. There can be problems with the connection between the implant and the prosthesis. There can be an infection or an inflammatory condition in the soft tissue and sometimes in the bone as a result of the implant placement. There can be damage to the nerves in the lower jaw and there can be damage to the maxillary sinus or the nasal cavity. All of these complications are rare and usually account for less than 5% of all dental implant treatments. These complications can usually be easily corrected.

Who should you see about Dental Implants?

The question is really who should you see about getting missing teeth replaced? Before implants, you went to either your general dentist or, if you wanted a specialist, to a prosthodontist. It's the same today. If you want to replace missing teeth, talk to the people who do that job and they will be glad to discuss the use of dental implants in that process. If you decide that dental implants are for you, then your general dentist or prosthodontist can either place the implants for you or refer you to a qualified surgeon, usually either an oral surgeon or a periodontist, for that phase of the treatment.

As our life span increases, the need for some type of permanent dental replacement system becomes very important to our overall health. Dentures and removable bridges have obvious problems: They are loose and unstable. Implants can provide people with dental replacements that are both functional and esthetic. The demand was always there, we just needed the tools to fulfill that demand.

Does it hurt to have Dental Implants placed?

The actual procedure to surgically place a dental implant is done under local anesthesia and is generally not at all painful. When the anesthesia wears off about three or four hours later, you might expect some discomfort. The level of discomfort is quite different from patient to patient, but most patients do not have significant problems. Some patients do have varying degrees of pain or discomfort which may last for several days. Swelling and black & blueing may also develop.

In cases where there is prolonged pain, you should see your dentist right away. Prolonged pain is not a good sign with dental implants and although it does not always mean failure, the cause of the pain should be determined as soon as possible. If an implant is not properly integrating into the adjacent bone or if an infection develops, the implant may have to be removed.

In some situations today, we still pay for these services according to the number of implants used. Dentistry, however, has realized that the number of implants used for a given restoration is most important in terms of the success of the restoration, not the overall fee and we have begun to start charging patients according to the complexity of the overall procedure.

It is certainly much more cost effective when the same dentist both places and restores a patient's dentition, but this is not always possible. In the future, as dental implants are incorporated into the scope of general practice, implants will be not only much more widespread in their use, but much more cost effective for the patients.

Perhaps one of the most frequently asked questions on this site is whether or not to use a fixed ("permanent") bridge or a dental implant to replace one or two missing teeth. Suppose you are missing your lower left first molar. If a fixed bridge were to be used, your dentist would cut down the adjacent teeth (the second molar and the second bicuspid) and fit a three unit fixed bridge over those two teeth. The missing tooth would be called a pontic and it would be effectively replaced by the three unit bridge. If your dentist were to use an implant with a crown on it, he would place an implant in the site of the original first molar.

He could do this immediately or at some date after the first molar was removed. There is no time limit here. The implant will take about 3 months to connect with the bone and then at that time, your dentist can construct a single crown on the implant to replace the missing first molar.

The cost of each one of these procedures varies from office to office, but a three unit fixed bridge costs about the same as an implant and a crown. The actual decision to do one over the other rests with you and your dentist.

One technique is not inherently better than the other and each depends upon how you present and your dentists skills. All things being equal, I would usually prefer to place the implant and crown over the bridge.

Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing.

If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own! Under proper conditions, such as placement by a periodontist and diligent patient maintenance, implants can last a lifetime. Long-term studies continue to show improving success rates for implants.

The impact of diabetes-related stigma

Amit Dwivedi

Who will marry my daughter who has diabetes?" asks Ram Anuj, a native of Ganga Jamuni village, Bahraich district in India. Ram Anuj's 14 years old daughter Munni (name changed) has type 1 diabetes and needs daily insulin injections.

The family members stopped sending Munni to school when other children made fun of Munni when she took her insulin. In a village-setting, giving insulin injections to Munni, is a public knowledge. Munni often gets scorned for being a burden on the family. Munni's family doesn't have enough money to take adequate care of her and provide the treatment she needs.

Stigma-related to diabetes, is particularly more pronounced for girls. Stigma in response to illness is not a new issue in some parts of the world. Stigma has long been associated with mental illness, physical disability, leprosy, cancer and tuberculosis. However, diabetes-related stigma is particularly severe as diabetes is a life-threatening chronic condition. Stigma is particularly complex as it operates at many different levels and has both social and psychological aspects. Diabetes-related stigma at the workplace or in the community and self-stigma has adverse impact on the mental health and feeling of wellness of people with diabetes. Primary definitions of stigma usually refer to Irving Goffman (1963) whose text provides seminal critique: "Stigma can be seen as an attribute that discredits the individual, denying full social acceptance, and where notions of social inclusion and exclusion are firmly brought to the fore."

There are many factors surrounding stigma including denial, shame, blame, fear, rejection and discrimination. For any child or adolescent living with diabetes, learning to cope with it is often a daunting task.

Dealing with a chronic illness such as diabetes may cause emotional and behavioral challenges, at times, leading to depression. The need for high-quality counseling sessions, for the people with diabetes and their family members, is paramount at the diabetes care and treatment centres, which may eventually help combat stigma. It may also help them to adjust to the lifestyle changes needed to stay healthy.

"Counseling and emphasizing that diabetes is not a disease but a metabolic condition and every person with diabetes should be referred to as a 'person with diabetes' and not a 'diabetic patient' will go a long way in reducing the diabetes-related stigma" stresses Dr Sharad Pendsey, a noted expert on diabetes, who runs a charitable trust - Diabetes Research Education And Management Trust (DREAM Trust, www. dreamtrust.org) in New Delhi. This trust provides free insulin, syringes, blood glucose monitoring strips and complete healthcare to the poor children with Type-1 diabetes. "Our centre has an education wing where diabetes educators regularly conduct educational classes, one to one counseling with patient and the family members. We have counselors at our centre and we have noticed a remarkable change in reducing diabetes related stigma" shares Dr Pendsey.

In addition, lack of skilled healthcare staff, apart from the treating diabetes physician, exacerbates the situation. There are not enough nurse educators, diabetes counselors, nutritionists, podiatrists (foot experts) and other health educators to help raise awareness and understanding of unique care and treatment needs of people with diabetes in society. This not only fuels the diabetes-related stigma but also reduces the quality of healthcare for people with diabetes. The treating physician is usually single-handedly dealing with all the different responsibilities of being a counselor, educator, doctor, nutritionist, podiatrist, to name a few. "The patients' inability/ unwillingness to pay for this additional support also hinders the treatment" says Dr Surendra Khanna, a Physician at Diabetes Centre in Kanpur.

According to International Diabetes Federation (IDF, www.idf.org), over 250 million people live with diabetes around the world. In addition, more than 200 children are diagnosed with type 1 diabetes every day, requiring them to take multiple daily insulin shots and monitor the glucose levels in their blood. Currently, over 500,000 children under the age of 15 live with diabetes. With such an enormous number of people with diabetes requiring attention, it is clearly vital to make the treatment, care and support services for people with diabetes made available in public sector hospitals without any further delay.

"Diabetes-related stigma can block access to existing diabetes-care services. If people with diabetes are felt to not be well anymore, then many mainstream systems do not want to spend their scarce resources on them, when they are fighting to have enough antibiotics and IV fluids to combat infections and diarrhoea, still the leading causes of death in children in the developing world. There are not enough specialists in many regions who are knowledgeable of diabetes to take care of all the children," said Mr Phil Riley, Campaign Director, World Diabetes Day Campaign (www.worlddiabetesday.org).

On this year's World Diabetes Day (14 November), let's hope that governments and other stakeholders will commit themselves to invest resources in mobilizing communities in a radical scale-up of awareness programmes, health education initiatives and treatment literacy efforts directed towards not only those living with diabetes but also their family members and people in the community. To reduce the diabetes-related stigma, and to create an enabling environment where people living with diabetes can live a normal healthy life, it is crucial to spread the message that often with appropriate lifestyle modifications type 2 diabetes is preventable, and that proper, affordable and accessible treatment, care and support programmes for people living with both type 1 and type 2 diabetes exist.