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PubMed2006

Bladder cancer and exposure to water disinfection by-products through ingestion, bathing, showering, and swimming in pools.

Bladder cancer has been associated with exposure to chlorination by-products in drinking water, and experimental evidence suggests that exposure also occurs through inhalation and dermal absorption. The authors examined whether bladder cancer risk was associated with exposure to trihalomethanes (THMs) through ingestion of water and through inhalation and dermal absorption during showering, bathing, and swimming in pools. Lifetime personal information on water consumption and water-related habits was collected for 1,219 cases and 1,271 controls in a 1998-2001 case-control study in Spain and was linked with THM levels in geographic study areas. Long-term THM exposure was associated with a twofold bladder cancer risk, with an odds ratio of 2.10 (95% confidence interval: 1.09, 4.02) for average household THM levels of >49 versus < or =8 micro g/liter. Compared with subjects not drinking chlorinated water, subjects with THM exposure of >35 micro g/day through ingestion had an odds ratio of 1.35 (95% confidence interval: 0.92, 1.99). The odds ratio for duration of shower or bath weighted by residential THM level was 1.83 (95% confidence interval: 1.17, 2.87) for the highest compared with the lowest quartile. Swimming in pools was associated with an odds ratio of 1.57 (95% confidence interval: 1.18, 2.09). Bladder cancer risk was associated with long-term exposure to THMs in chlorinated water at levels regularly occurring in industrialized countries.

Adult↗
PubMed2006

Waterborne diseases prevention: evaluation of inspection scoring system for water sites according to water microbiological tests during the Athens 2004 pre-Olympic and Olympic period.

STUDY OBJECTIVES: To evaluate the inspection grading system for water sites implemented during the Athens 2004 Olympic inspection programme. DESIGN: The relation between the standardised inspections results of 716 water supply systems and 289 public swimming pools, and microbiological test results of 2358 samples collected during inspections was examined. SETTING: Athens, Thessaloniki, Patra, Volos, and Iraklio, Greece. Inspections and sampling conducted during a two year period before the 2004 Olympics. MAIN RESULTS: Swimming pools unsatisfactory inspection grading results were significantly associated with positive water microbiological test results (relative risk = 2.5, p<0.05). One of the six violations of swimming pools and five of the seven violations of water supply systems designated as "critical" water safety hazards in the inspection reports were significantly associated with positive microbiological test results. The receiver operating characteristic analysis identified the unsatisfactory score designed in the swimming pools standardised inspection report, as the ideal score (-15), in adequately producing positive microbiological test results (sensitivity 13.2%, specificity 89%). CONCLUSIONS: This study shows the utility of standardised inspection grading systems in waterborne diseases prevention planning and implementation strategies of policy makers and regulators. Future water quality assessment should be based on the implementation of a robust standardised inspection system and reduce the need of microbiological tests.

Data Collection↗
PubMed1980

Spinal cord injuries due to diving.

One hundred and fifty patients with spinal cord lesions due to diving accidents were admitted to Stoke Mandeville Hospital between 1944--77. Most of the patients were young men, 65 had dived into the sea, 48 into swimming pools, 21 into rivers and 3 into lakes. Injuries due to diving into the deep end of swimming pools appear to have been eliminated in Great Britain but injuries due to diving into the shallow end of swimming pools and into the sea continue to occur. The public need further education about the dangers of diving.

Adolescent↗
PubMed1993

Study of free living amoebae in Egypt.

At different locality in Egypt, free living amoebae (FLA) were detected in 32%, 20% and 4% of water samples obtained from swimming pools, surface water canals and tap water respectively. Naegleria spp. were identified from 12 (75%) out of 16 swimming pool samples and 6 (60%) out of 10 surface water & canals samples from different Governorates in Egypt, while Acanthamoeba spp. were identified from 4 (25%) of 16 swimming pools samples, 4 (40%) out of 10 surface water & canals samples and 2 (100%) tap samples. The isolated FLA in the present study were non-pathogenic as proved by the pathogenicity test.

Amebiasis↗
PubMedDate not supplied

Rapid determination of bacteria in pools.

If a method for rapid determination of bacterial levels in swimming pools and whirlpools were available, bacterial health risks could be avoided before exposure occurred. Such a method would enable public-health authorities to make timely decisions about closing or reopening pools and to adjust disinfectant doses. The purpose of this study was to determine if a rapid adenosine triphosphate (ATP) bioluminescence method would serve this purpose. Bacteriological analyses were completed on samples from swimming pools and whirlpools in Washtenaw County, Michigan. The results from the ATP assay were compared with those from the conventional plate count method and were found to be highly correlated (r = .92). To assess whether a prefiltration step was necessary to delete nonbacterial ATP--which might originate from bathers' skin cells or other debris--two procedures were tested: one with prefiltration and one without prefiltration. The results for prefiltered samples were not statistically different from the results for non-prefiltered samples (p > .05), for both the heterotrophic plate counts and the ATP bioluminescence method. This study indicates that the ATP assay can estimate bacterial levels in pools within minutes and without prefiltration.

Adenosine Triphosphate↗
PubMed1961

Algicidal and sanitizing properties of Armazide.

Algicidal and sanitizing properties of Armazide, a new swimming pool additive, consisting of 12% w/v each of dodecylamine hydrochloride, trimethyl alkyl ammonium chloride, and methyl alkyl dipolyoxypropylene ammonium methyl sulfate in solution, were evaluated by laboratory techniques against algae and sewage. Results indicated it to be highly effective in low concentrations especially in conjunction with low concentrations of chlorine. Swimming pool field tests were found to confirm the laboratory findings. Various treatment levels and methods are described for swimming pools using treatments based upon the actual condition of the pool and water. The use of the product permitted a reduction in chlorine residual in pools resulting in greatly reduced requirements for chlorinating chemicals along with absence of irritation, odor, and other undesirable results usually associated with standard pool chlorination methods.

Chlorine↗
PubMed2002

A randomized trial of skin cancer prevention in aquatics settings: the Pool Cool program.

Skin cancer is increasing, and prevention programs are essential. This study evaluated the impact of a skin cancer prevention program on sun-protection habits and swimming pool environments. The intervention included staff training; sun-safety lessons; interactive activities; providing sunscreen, shade, and signage; and promoting sun-safe environments. A randomized trial at 28 swimming pools in Hawaii and Massachusetts tested the efficacy of this program (Pool Cool) compared with an attention-matched injury-prevention control program. Results showed significant positive changes in children's use of sunscreen and shade, overall sun-protection habits, and number of sunburns and improvements in parents' hat use, sun-protection habits, and reported sun-protection policies and environments. Observations corroborated the positive findings. Pool Cool had significant positive effects at swimming pools in diverse audiences.

Child↗
PubMedDate not supplied

Pseudomonas folliculitis: an outbreak and review.

In November 1980, an outbreak of folliculitis due to Pseudomonas aeruginosa occurred in members of a health spa in Tennessee. The source of infection was traced to the health spa swimming pool, which had not been chlorinated for two days due to equipment malfunction. Thirty-seven (62%) of 60 members who used the swimming pool on these two days developed a papulopustular rash within eight hours to five days after swimming in the pool. The rash had a characteristic distribution, predominantly involving the buttocks, hips, and axillae. Other manifestations of infection included otitis externa (49%) and mastitis (11%). P. aeruginosa serogroup 0-11 was isolated from pustules of six people. A swab from the edge of the swimming pool also grew P. aeruginosa serogroup 0-11. With the rising popularity of home whirlpools and hot tubs, physicians may expect to encounter this disease with increasing frequency.

Disease Outbreaks↗
PubMed2005

Drowning of British children abroad.

AIMS: To quantify the risks of British children drowning abroad. METHODS: The numbers of British children drowning abroad were estimated for 1996-2003 using the RoSPA/RLSS press cutting database. We compared these figures with the numbers of British children going abroad from the International Passenger Survey from the Office of National Statistics. RESULTS: Sixty-eight children (45 boys-23 Girls) drowned in the eight-year period: 48 (71%) in swimming pools (mostly in hotels). Allowing for exposure, the rate was higher in North America [5.2 (CI 2.9-9.4)/million tourists] than the European Union [1.9 (CI 1.4-2.5)/million tourists] p = 0.002. DISCUSSION: On average eight British children drown each year abroad. This is therefore a rare but tragic event. Most of these episodes happen in swimming pools and this needs to be compared to the one child that dies each year in municipal swimming pools in the United Kingdom where there is adequate lifeguarding. It may be that parents have a false sense of security for their children in pools abroad. We believe that there needs to be action from the European Union on this important event.

Accidents↗
PubMed2002

Incidence of Pseudomonas aeruginosa in recreational and hydrotherapy pools.

Pseudomonas aeruginosa remains an important agent of opportunistic infection in patients, particularly those with respiratory complications and burns. One natural niche of this organism is water and water-associated facilities, hence the aim of this study was to examine specimens from recreational and hydrotherapy pools in Northern Ireland over a two-year period. Water specimens (n = 3,510) were obtained from three amenity categories, namely, 13 hydrotherapy pools (specimen number [n] = 323), 51 Jacuzzis/spas (n = 1,397) and 68 swimming pools (n = 1,790). Specimens (100 ml) were filtered through a cellulose acetate (0.45 micron pore size) gridded filter and the membrane was placed on Pseudomonas CFC agar (Oxoid CM559 + SR103) and incubated at 37 degrees C for 48 +/- 2 h. Colonies that clearly showed pyocyanin production or met other identification criteria were considered P. aeruginosa. Of the amenities examined 4/13 hydrotherapy pools (30.8%), 37/51 Jacuzzis/spas (72.5%) and 26/68 swimming pools (38.2%) were positive for P. aeruginosa. The most heavily contaminated amenity category was the Jacuzzi/spa, where 34.7% and 12% of private and public sites respectively were positive for P. aeruginosa at a level of greater than 1,000 cfu 100 ml-1. Approximately twice as many samples were positive in private Jacuzzis/spas compared to publicly operated facilities. There was a similar trend with respect to public and private hydrotherapy pools, though bacterial counts did not exceed 1,000 cfu 100 ml-1. Recreational and therapeutic amenities involving the use of water may be a potential source of P. aeruginosa for susceptible patient groups, including patients with cystic fibrosis and bronchiectasis. This may vary depending on amenity type and public/private ownership of such amenities.

Humans↗
PubMed1983

Isolation and identification of pathogenic Naegleria australiensis (Amoebida, Vahlkampfiidae) from a spa in northern Italy.

Samples from therapeutic swimming pools and mud basins were cultured for free-living amoebae. Seven strains of pathogenic Naegleria species were isolated. Although some of the strains were as virulent as Naegleria fowleri, the etiological agent of primary amoebic meningoencephalitis, they were identified as Naegleria australiensis with the indirect fluorescent-antibody technique. The virulence of the isolates for mice corresponded with the cytopathic effect for Vero cells. The N. australiensis strains were isolated from swimming pools with water temperatures ranging from 32 to 35 degrees C and from mud with temperatures from 25 to 43 degrees C. The presence of pathogenic N. australiensis in the swimming pools did not correlate with bacterial indicators.

Amoeba↗
PubMed1988

[Green hair: clinical, chemical and epidemiologic study. Apropos of a case].

A 36-year-old blond woman suddenly developed green tinted hair following exposure to swimming pool water. This was the first green discoloration she noticed, although she had been an active swimmer for several years. Clinical examination showed green tinting toward the distal ends of the most superficial strands of hair. The copper content of plucked green hair measured by atomic absorption was elevated to 3,900 ppm and the copper concentration in water from the swimming pool implicated was 9.94 ppm. Following renewal, the latter value decreased to 107 ppb. Hair examination under polarizing light was normal, and a scanning electronmicroscopic study of hair samples showed a total loss of cuticle with micropits scattered over the hair shaft surface mimicking a "dead tree trunk". Epidemiological investigations showed that the increased copper content of swimming pool water was due to added algaecides without adequate replacement of the water. Hair damage resulting from repeated waving and/or bleaching of the hair turns out to be an important factor in the deposition of copper by inducing an increase in keratin content of cysteic acid and related anionic sulfonate groups which participate in copper adsorption. On the ocassion of this case-report, epidemiological data published by others, together with the chemical and therapeutic aspects of green hair are reviewed.

Adult↗
PubMedDate not supplied

[Bacteriological study of seawater for recreational use].

A study was conducted at the request of the authorities of the Municipality of Bahía Blanca city, in order to decide whether the sea-water of a swimming pool was suitable for recreational purposes. The characterization of the water was performed through bacteriological indicators and the following groups of bacteria were studied: marine and terrestrial viable aerobic heterotrophic bacteria; total coliforms; Escherichia coli and fluorescent Pseudomonads. Salinity, temperature and pH were registered together with meteorological parameters. In every case, the bacteriological values obtained were lower than those of the most strict international standards used worldwide for bathing waters. In this way, the particular dynamic processing of the water entering the swimming pool from Blanca Bay becomes important, since previous studies conducted on the water of its Principal Channel had yielded high bacteriological values which rendered it unsuitable for bathing. This work shows that in this tidal-flats system, extrapolation of results is not valid. These conditions will remain the same if other factors do not change in the tidal-flats that surround the swimming pool.

Bacteria↗
PubMed1996

Drowning fatalities of children in Tasmania: differences from national data.

All drownings of people under 15 years of age in Tasmania from 1981 to 1993 were identified from the Tasmanian coroner's case files. Age- and sex-specific mortality rates were calculated and found to be similar to Australian drowning mortality rates. An exception was the lower drowning rate for Tasmanian females aged 0 to 4 years. Only 9 per cent of drowning deaths were caused by immersion in a swimming pool, 32 per cent of deaths occurred in dams and ponds and 21 per cent occurred in a river. Most drownings (88 per cent) associated with dams, ponds, swimming pools and baths were in the 0-to-4-year age group. Compared with Australia as a whole, toddlers drowning in swimming pools is uncommon in Tasmania; however, there are relatively more drownings in dams and ponds. Strategies for the prevention of drowning in childhood in Tasmania should consider the hazards associated with rural living.

Adolescent↗
PubMed1979

The occurrence of negative middle ear pressure in children: an analysis of supposed associated factors.

This study analyzed the occurrence of negative middle ear pressure in various groups of children by comparing them with control groups. A screening procedure recording middle ear pressure and screening audiogram was performed several times throughout the year in an unselected group of 352 seven-year-old children. From about 4000 measurements of middle ear pressure an average value for each child was calculated. By applying thresholds of pathology of -160 mm H2( and -240 mm H2O, the occurrence of pathology in the different groups was analyzed. A medical history of each child was obtained by questionnaires answered by parents, giving information concerning allergy, previous adenoidectomy, previous exposure to respiratory tract infections and the social group of the family. A score of dental caries was obtained in each child. Furthermore, the relationship to antibiotic treatment and the child's use of swimming pools was analyzed, based on single measurements. The use of swimming pools seems to be beneficial to children suffering from a negative middle ear pressure. However, the other variables showed no relationship to negative middle ear pressure. It is concluded that other unknown factors must be involved in the development of negative middle ear pressure and chronic OME in children.

Adenoidectomy↗
PubMed1990

Drownings in Florida 1977-1986.

Drowning is a serious public health problem in Florida. It is the leading cause of death among children aged one to four years. We studied Florida drownings for 1977-1986 using data from the Florida vital statistics mortality file and found that 5,525 occurred, the greatest number in 1980 (688), the fewest in 1985 (453). The reasons for this decrease are not clear, but the greatest decrease occurred in swimming pool drownings. Nonwhite males had the highest overall drowning rates, except for those under age five or 80 and above. White males had the highest drowning rates for persons under age five; most of these occurred in swimming pools. No single approach will prevent drownings in all high risk groups. Priority should be given to foursided fencing of swimming pools and to further study of nonwhite male drownings.

Accidents, Home↗
PubMed1995

Intensive swimming: can it affect your patients' smiles?

Athletes who swim intensively, such as those who swim laps more than six hours a week, may develop unusual yellowish brown or dark brown stains on their teeth. The authors hypothesize that long-term contact of the teeth with swimming pool water, as well as the mixture of oral fluids with swimming pool water, leads to the formation of these deposits. The authors report two cases of development of such stains.

Adolescent↗