[Whirlpool baths and hygiene].
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Biomedical subjects
Publications and source records attributed to J Steensberg.
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After using a whirlpool-spa when the chlorine concentration in the water was very low (0.1 mg/l free chlorine) approximately 20 persons developed a follicular rash. No cases were registered in bathers when the chlorine concentration was acceptable (0.9-1.2 mg/l). The same sero-group and phagetype of Pseudomonas aeruginosa was cultivated from a patient and from the piping system of the spa. The importance of following directions for the installation of whirlpool-spas and regulations for their operation and control is strictly stressed. The National Agency for Environmental Protection is asked to reinforce the existing regulations concerning whirlpool-spas.
The effect of heavy short-term physical exercise on the levels of complement receptor type one (CR1, CD35) on erythrocytes, the concentrations of circulating immune complexes (IC), and the complement C3 split products C3c and C3d were examined in young healthy males. Fourteen untrained volunteers underwent a 60-min bicycle exercise test at 75% of maximal oxygen uptake (VO2max). Six of the volunteers were exercised twice with an interval of at least one month. Before the second bicycle test they received oral indomethacin. With an interval of at least 1 week, 6 also went through a 60-min back-muscle exercise at up to 30% of VO2max. Blood samples were collected before and during the last few minutes of exercise as well as 2 h and 24 h afterwards. The same parameters were examined once in 29 highly trained racing cyclists. There were no consistent or significant exercise-induced changes in the levels of erythrocyte CR1, circulating IC, C3c nor C3d as measured by an enzyme-linked immunosorbent assay, polyethylene glycol precipitation complement consumption method, and by intermediate gel rocket immunoelectrophoresis, respectively. Neither did these parameters differ from controls in the highly trained group. The results indicate that CR1 on erythrocytes, circulating immune complexes and complement cleavage products C3c and C3d in healthy subjects remain unaffected by short-term heavy physical activity and training.
The environmental health situation in the Soviet Union is characterized by, e.g. a higher incidence of gastrointestinal infections, greater problems with water hygiene and more extensive air pollution than in the Nordic Countries. The difficult supply situation leads to compromises in the food control system. It is difficult to ensure sufficient nutrition of pregnant women and children. Dwellings are overcrowded. The present reorganization of the economic system and lack of resources mean that it is difficult to give high priority to environment considerations.
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Based on case material from the late 1970s and early 1980s from the Institution of Medical Officers of Health covering a Danish county some examples of practical indoor climate problems in day institutions for children are given. Insufficient ventilation of premises is probably the single most important factor in the development of indoor climate problems. An effective cleaning generally improves the indoor air. The study particularly illustrates the administrative and policy perspectives of the decision making process. Those that make decisions on indoor climate problems unfortunately seem to favour a narrow definition of health, i.e. the absence of overt disease; and they are not always aware that the relationship between indoor climate factors and health effects cannot be proven in an absolute sense. Experts on the scientific aspects are needed but their statements are influenced by personal values and their perception of the reasonable balance between health protection and social costs. One of the main factors influencing the indoor climate situation in Danish day institutions for children has been the lack of an adequate regulatory framework; and the central administration and responsible ministers have failed to use the already existing legislative powers to prevent problems. Decision making in cases on the indoor climate of institutions should be accelerated; we cannot wait for proof before taking preventive measures. The indoor air of institutions is a "public good" to the same extent as the ambient air and the responsible authorities have an obligation to regulate accordingly. When building regulations prove insufficient other central authorities must support local decision makers with more specific directions. Testing of building materials, hazard rating and an approval system is needed. Guidelines on indoor climate requirements for public institutions should be developed. In countries with a built-up system of child institutions and a decreasing birth rate it is especially important to improve the already existing institutions. In our regulatory and administrative practice we must restore the balance between the present concern for the health of the adult working population and the insufficient protection of children. We obviously need more research but increased attention should be paid to the administrative and political barriers that prevent improvements of the indoor air.
An outline is given of the data on human health effects that are needed as a foundation for the administration of legislation on chemical substances and products. Danish data on mortality and morbidity from acute poisoning and some published clinical studies are presented. Serious problems may persist in subgroups of the population and the prevention of acute poisoning is still a basic aim of this legislation. Allergic reactions to chemicals are discussed. Not all sensitized individuals can be protected but steps should be taken to prevent contact with the sensitizing agents that are of the greatest public health importance. Chronic health effects following exposure to chemicals have influenced the recent strengthening of regulations but carcinogenic risks especially are extremely difficult for administrative and political systems to handle in an approximately rational way. While we are reducing the use of suspected carcinogenic chemicals our populations must, however, be given a greater appreciation of the cancer risk problem, particularly the fact that we cannot eliminate all cancer risks. Biological monitoring of human populations is a necessary supplement to the traditional registration of diseases as part of our health surveillance systems. Fortunately our societies have been able to pay increasing attention to the long-term public health consequences of exposures to chemical factors in our environment.
The clinically working medical doctors are insufficiently trained in epidemiology and community medicine. They are, therefore, not sufficiently aware of health related environmental factors. They cannot avoid the difficulties of generalizing clinical observations because of small numbers and the long latency period in chronic disease evolution. As centralization of treatment is not generally possible we must improve our systems for registration of environmentally induced disease and health monitoring of the population. Finally, the clinicians should be more concerned with follow-up of administrative disease preventing actions.
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