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PubMed1997

Caregiver factors and pool fencing: an exploratory analysis.

OBJECTIVES: To explore the relationship between caregiver characteristics and the adequacy of domestic swimming pool fencing. SETTING: A typical metropolitan area of a large Australian capital city, Brisbane. METHODS: From a reanalysis of the dataset of the 1989 Brisbane Home Safety Survey of 1050 householders, associations between 10 caregiver factors, pool ownership, and quality of pool fencing, were analysed. Household characteristics relating to toddlers (children < or = 4 years), and socioeconomic measures were also included in the analyses. Pool fencing quality was measured on an ordinal scale derived from Australian Standards Association guidelines, confirmed through home visits by trained inspectors. RESULTS: Caregiver factors did not distinguish households with a swimming pool from those without, nor were they associated with adequacy of pool fencing among pool owners. Pool owners, with or without children, were less likely to perceive having a childproof fence as being important. Strongest correlates of adequacy of pool fencing were socioeconomic indicators of surrounding districts. CONCLUSIONS: These results do not support the arguments of opponents of compulsory pool fencing that caregiver factors are adequate to prevent toddler drownings and obviate the need for a pool fence. Pool owners do not appear to perceive their pool as a hazard for young children, and complacency about the adequacy of pool fencing needs to be replaced by increased caregiver health beliefs, skills, and perceptions.

Accident Prevention↗
PubMed2000

A study of dental staining among competitive swimmers.

OBJECTIVE: To estimate the prevalence of dental stains (DS) in competitive swimmers and quantify the risk of these stains compared with sportsmen in a non-swimmers group in Castellón, Spain. METHODS: Cross-sectional and case-control designs. Between July 1996 and March 1997, 404 subjects, (171 enrolled in two clubs of competitive swimming and 233 sportsmen from two schools), were examined in order to detect and classify yellowish-brown or dark-brown stains on the facial surface of the eight incisors. Participation rates were 88.6% for swimmers, and 95.7% for sportsmen. Mean of participants' age was 12 years, range 7-22 years. Castellón has three public competition swimming pools, two of which are indoors. Two of the pools used chloride products, and the third bromine for the disinfection of water. The recommended hygiene regulations were adhered to. RESULTS: Prevalence of DS was 60.2% in swimmers and 12.9% in sportsmen (P= 0.0001). Risk factors for DS included: use of competition swimming pools, age, gender, years of competition, daily consumption of coffee, red wine, and iron supplement during the last year. Professional dental cleanliness was a protective factor. In a logistic regression analysis, the use of competition swimming pools maintained a high risk of DS, odds ratio (OR)=9.28; 95% confidence interval (CI) 5.21-16.5, adjusted by the other variables. Amongst swimmers, more than 6 h of training a week increased the risk of these stains (OR=3.51; 95% CI 1.35-9.10). CONCLUSION: The study indicated a high risk of DS in competitive swimmers.

Adolescent↗
PubMed2004

Ecological limitations on aquatic mosquito predator colonization in the urban environment.

Urban malaria cases are becoming common in Africa as more people move into cities and industrialization proceeds. While many species of Anopheles mosquitoes vector malaria in rural areas, only a few are found within cities. The success of anthropophilic species in cities, such as members of the An. gambiae complex, may be explained by limitations on colonization by predator species in urban environments. Habitats that are temporal or structurally simple have lower predator survivorship in a variety of ecosystems, but these have not been investigated previously in an urban area. Areas within and around the Kenyan coastal town of Malindi were previously sampled for the presence of standing water using a geographic sampling strategy with probability proportional to size sampling of planned well-drained, unplanned poorly-drained, planned poorly-drained, unplanned well-drained, and peri-urban locations. Standing aquatic habitats in these areas were reassessed. During monthly sampling, presence/absence of mosquitoes and predator taxa were noted, as were ecological habitat variables: structural complexity and presence of water. Lambda statistics were calculated to associate predator guilds, habitat types, location variables, and ecological variables. All predator guilds found in habitats were strongly associated with habitat type, as were the structural complexity and temporal nature of the habitats. Types of habitat were heterogeneously distributed throughout Malindi, with swimming pools as a common habitat type in planned urban areas and tire track pools a common habitat type in peri-urban areas of Malindi. Predator colonization of aquatic habitats in Malindi was strongly influenced by habitat type, and not associated with location characteristics. Ecological variables were affected by the type of habitats, which are co-associated with planning and drainage in Malindi. While habitat types are distributed heterogeneously within Malindi, habitats with low predation pressure are available for mosquito colonization in both urban and peri-urban areas. The temporal, peri-urban tire track pools and the structural simplicity of urban swimming pools may discourage predator colonization, thereby increasing the probability of malaria vectors in these areas of Malindi. Future studies should evaluate habitats for use in malaria surveillance and experimentally test the effects of structural complexity and temporal nature of urban habitats on the densities of mosquito larvae and their aquatic predators.

Animals↗
PubMed2000

Pseudomonas dermatitis/folliculitis associated with pools and hot tubs--Colorado and Maine, 1999-2000.

During 1999-2000, outbreaks of Pseudomonas aeruginosa dermatitis and otitis externa associated with swimming pool and hot tub use occurred in Colorado and Maine. This report summarizes these outbreaks and provides recommendations for swimming pool and hot tub operation and maintenance, particularly when using offsite monitoring of water disinfectant and pH levels or when cyanuric acid is added to pools as a chlorine stabilizer.

Colorado↗
PubMedDate not supplied

A swimming pool-associated outbreak of Cryptosporidiosis in British Columbia.

An outbreak of Cryptosporidiosis occurred over three months in a British Columbia community, peaking in December 1990. Results of the case-control study and illness surveys support the hypothesis that transmission occurred in a public children's pool at the local recreation centre. Analysis using lab-confirmed cases revealed a matched odds ratio of 4.5 [95% CI 0.97, 20.83], and using clinical cases an unmatched odds ratio of 12.8 [95% CI 3.68, 46.77], associated with swimming in the children's pool within two weeks prior to onset of illness. Other risk factors were not significant. Attack rates in various groups of children's pool users ranged from 8% to 78%. The children's pool was closed for steam cleaning and disinfection. Unusually frequent defecations including liquid stools had occurred before and during the outbreak. Improvements were instituted for removal of feces and superchlorination of pool water.

Adolescent↗
PubMed1975

Adeno-associated virus in adenovirus type 3 conjunctivitis.

Although human infection with adenovirus-associated virus (AAV) has been demonstrated, there is no evidence that disease results from such infections. The proportion of adenovirus infections which are dual infections with AAV is virtually unknown, since special methods are required to demonstrate infection with AAV. To search for AAV, we re-examined a collection of specimens from 40 persons involved in an epidemic of pharyngoconjunctival fever associated with a swimming pool. Virological and serological studies indicated that the etiological agent was adenovirus type 3. When the 91 original eye, throat, and fecal specimens were re-examined, using methods suitable for detection of adenovirus and AAV, 37 strains of adenovirus type 3 and 35 strains of AAV type 3 (AAV3) were isolated. Surprisingly, 19 AAV3 but only 11 adenovirus isolates were found in eye specimens, whereas adenovirus isolates were equally distributed in all types of specimens. Four AAV3 strains were isolated from adults. Significant (fourfold or greater) rises in AAV3 complement-fixing antibody titers were seen in six of 14 persons shedding AAV3, whereas nine of 10 persons shedding adenovirus type 3 showed significant rises in adenovirus complement-fixing antibody. These results raise the question whether AAV persists better in eyes than adenovirus or that a possible association with conjunctivitis might be present. In contrast to the results in the specimens from the swimming pool epidemic, only one of 36 adenovirus strains isolated in other Seattle-based studies yielded AAV. Complement fixation tests on serial sets of sera collected from 60 children not involved in the swimming pool episode revealed nine AAV2 and 12 AAV3 infections during a 4-year period.

Adenoviridae↗
PubMed2005

Diffusion of an effective skin cancer prevention program: design, theoretical foundations, and first-year implementation.

This article describes the design and theoretical foundations of the Pool Cool Diffusion Trial and reports 1st-year findings. Aims of the study are to evaluate the effects of 2 strategies for diffusion of the Pool Cool sun safety program on implementation, maintenance, and sustainability; improvements in environmental supports for sun safety in swimming pools; and sun protection habits and sunburn among participating children. There was a high rate of program participation (86.6%; n=375 swimming pools) in the 1st year and somewhat lower study participation (75.8%). Analysis of pool manager surveys revealed a time effect for overall sun safety programs and for sun safety policies, environmental strategies, and programs for pool users. There were few differences in implementation between treatment groups in year one.

Child↗
PubMed1999

Achieving compliance with pool fencing legislation in New Zealand: a survey of regulatory authorities.

OBJECTIVES: To identify the status of compliance and enforcement of New Zealand's Fencing of Swimming Pools Act (FOSP Act), 10 years after its introduction, and to identify methods for improving both compliance with the act and the process of enforcement. METHODS: A postal questionnaire was sent to all 74 authorities in New Zealand in which they were asked questions about their enforcement of the FOSP Act. Semistructured telephone interviews were conducted with 12 authorities to supplement the data obtained in the postal survey. RESULTS: Based on responses to the survey, it was estimated that there are over 59,000 domestic swimming pools in New Zealand, giving rates of 46 pools/1000 dwellings and 16 pools/1000 persons. The authorities reported that 44% of pools complied with the act, and a further 4% had been granted exemptions. Nineteen per cent of pools were reported to not comply with the act, and the compliance status of a further 33% was not known, or not stated by the authority. Only 9% of authorities had procedures for locating and inspecting pools, while 28% had a programme of reinspection to ensure that pools continued to comply. Pool owner resistance was considered to be the main difficulty with enforcing the act, and nearly half of the authorities believed publicity or education was needed to overcome these barriers. Fifty two per cent of authorities had publicized the act during the 12 months preceding the survey. CONCLUSIONS: Due to ambiguities within the legislation, and differing levels of commitment by authorities to locate pools and monitor compliance, compliance with the FOSP Act is not consistent nationally. If the act were less ambiguous, there would be greater consistency and more enforcement.

Accident Prevention↗
PubMed1992

[Legionella contamination in warm water systems of a large German city].

Since 1988 the Frankfurt City Health Department examined the hot water systems of all public indoor swimming pools, old age homes and hospitals, and made subsequent checks on the corrective measures introduced. In the 6 public indoor swimming pools the percentage of positive legionella findings, after corrective measures has dropped since 1988: at the central hot-water supply units from 47% to 23%, and at the peripheral tap connections from 66% to 22%. The number of negative samples rose from 43% to 77%. Thus the favourable effect of the corrective measures is demonstrated. Since 1988 samples have been taken from the shower water at old age homes. An increase in negative findings could be shown (from 58% to 70%). From 1990, however, an increase of high-level legionella contamination (> 10,000 Legionella colonies per litre) was detected as well. In one home with a generally high legionella contamination level (up to 75,000 legionella colonies per litre) an investigation of the legionella antibodies was done in the blood of 44 residents whose medical history included fever or bronchial symptoms. In no case a previous infection could be demonstrated. However, there was one patient with a definite legionella pneumonia in the home: this patient usually had been showering for at least 20 minutes a day. Legionella were found in the hot water systems of 16 of the 17 hospitals in Frankfurt. In 1991 more than half to the 204 samples were legionella positive. 5% of the samples had legionella contamination levels of more than 100,000 per litre. Corrective measures have been taken.(ABSTRACT TRUNCATED AT 250 WORDS)

Colony Count, Microbial↗
PubMed2006

Assessment of lifetime exposure to trihalomethanes through different routes.

OBJECTIVES: To evaluate lifetime exposure to trihalomethanes (THM) through ingestion, inhalation, and dermal absorption in a hospital based case-control study of bladder cancer conducted between 1998 and 2001 in five areas of Spain. The study base was comprised of subjects living in the catchment areas of the participating hospitals. METHODS: Individual information on water related habits was obtained from personal interviews of 1219 cases and 1271 controls: residential and occupational history, drinking water source at each residence and job, amount of water consumption, frequency and duration of showering, bathing, and swimming pool attendance. THM levels, water source history, and year when chlorination started in study areas were ascertained through measurements in drinking water samples and questionnaires to water companies and local authorities. Estimates of THM levels covered 79% of the subjects' person-years of exposure. RESULTS: Current and historical average THM levels in water were correlated. Control subjects reported that drinking water source in the last residence was municipal for 63%, bottled for 22%, private well for 2%, and other sources for 13%. For the time window between age 15 and the time of interview, average residential THM level was 32.2 mug/l. THM exposure through ingestion was 23.7 mug/day on average, and was correlated with the ingestion THM level in the workplace. Overall, 79% usually took showers, 16% usually took baths, and 13% had ever attended a swimming pool. Between 21% and 45% of controls unexposed to THM through ingestion were evaluated as moderately or highly exposed through showering or bathing, and 5-10% were exposed through swimming in pools. CONCLUSION: The importance of evaluating different routes is underscored by findings from experimental studies showing substantial differences in THM uptake and internal distribution by route.

Adult↗
PubMed1992

[Construction hygiene in the area of bathing and recreation].

Construction hygiene in the bathing and recreation areas underwent many changes during the decades. In each case it was accomplished very intensively and defined by the actual needs of the population or by those responsible for the population. With regard to the development of bathing since the Romans, the bathing habits of the Roman times, during the Middle Ages, at the 18th century, at the beginning of the 19th century and of today are characterized broadly. The respective constructional as well as the hygienic measures are also shown and discussed in this context. Whereas the Roman thermals created prerequisites for physical activity as well as possibilities for spare time, and in the early Middle Ages, sexual excesses and the risk factors connected thereby led to the transfer of infectious diseases and consequently to the elimination of the public baths. At the beginning of the 18th century first the cleaning of the body and at the beginning of the 20th century physical activity became very important. With the help of the construction plans for baths and shower-baths and swimming pools of 1906 the aims and purposes of the baths are discussed and the respective constructional changes are shown the example of warm water baths (swimming pools) in Hamburg.(ABSTRACT TRUNCATED AT 250 WORDS)

Baths↗
PubMed1983

Prevalence of infection with nonpolio enteroviruses among healthy children from a children's home and in a summer camp.

The sera obtained at 6 samplings between June 1981 and May 1982 from 30 children in a children's home were tested for neutralizing antibodies to coxsackieviruses B1 through B5, echovirus serotypes 1, 2, 4, 5, 6, 7, 11, 19, 24, 30 and to enterovirus type 71. Another group of examined children comprised 19 individuals from the children's home and 63 children from families who enrolled as participants of a summer camp recreation. Samples of their sera were obtained at the beginning and the end of camping in July and August of 1981. Virus isolations were attempted in 150 stool specimens collected at various times during the observation period, and in specimens of summer camp swimming pool water collected 2-3 times a week. Overall, 10 strains of enterovirus (CB2, E2, E19, E24) were isolated from stool, but none from swimming pool water. Serologically, fourfold or greater increases in titre of antibody to at least one of the enteroviruses tested were observed 17 children, of whom 4 children showed antibody titre increases simultaneously to two enterovirus serotypes. None of the present viruses showed a tendency to mass spread. Some of the examined children showed the presence of serum antibody to enterovirus before its isolation from stool. Eight of the ten children positive for enterovirus in stool did not react by significant increases in titre of antibodies. Enteroviruses were more frequently isolated in children's home in autumn than in summer camp. Clinically, all virologically or serologically demonstrated enteroviral infections were asymptomatic. Children's home children had a significantly higher prevalence of antibodies to enteroviruses than children from families. Presumably, asymptomatic infections with nonpolio enteroviruses among children appear to be far more frequent than the results of neutralization tests in the study indicated. Moreover, enteroviruses may apparently circulate among humans who are seropositive for the respective enterovirus serotype.

Adolescent↗
PubMed2000

Prevention of spinal cord injuries caused by diving: evaluation of the distribution and usage of a diving safety video in high schools.

OBJECTIVE: To determine and assess the distribution and use of Sudden Impact, a video designed by Think First and SportsSmart Canada, to help prevent spinal cord injury caused by careless shallow water diving among teenagers in the high risk group (15-24 years old). DESIGN: Survey of 92 public secondary schools in Toronto, Canada. SUBJECTS: The heads of the physical and health education departments of the 92 secondary public schools in the Metropolitan Toronto region. RESULTS: The response rate was 64% (59 schools), of which 76% (45) had actually received the video. Forty one schools (91%) of those that received the video reported using it. Eighty per cent of responding schools showed it to grade 11 students. Eighty per cent of schools with swimming pools used the video compared with only 42% of schools without swimming pools. CONCLUSIONS: There is a need for improvements in the system of distribution to ensure greater use of material such as this video. These may include direct distribution to principals, continuing contact with the schools, or mandatory inclusion of diving safety into the school curriculum.

Adolescent↗
PubMed2000

Effects of pool-fencing ordinances and other factors on childhood drowning in Los Angeles County, 1990-1995.

OBJECTIVES: This study estimated the effects of local pool-fencing ordinances and other factors on the rate of childhood drowning in Los Angeles County, California. METHODS: Stage 1 was a retrospective dynamic cohort study of all drownings among children younger than 10 years that occurred in residential swimming pools in Los Angeles County between 1990 and 1995. Stage 2 was a matched case-control study that compared pools in which childhood drownings occurred (cases) with randomly selected pools in which drownings did not occur (controls). RESULTS: The drowning rate was relatively high among toddlers (aged 1-4 years), boys, and African Americans and in areas with a high density of residential swimming pools. Pool-fencing ordinances were not associated with a reduced overall rate of childhood drowning. CONCLUSIONS: Local ordinances enacted in Los Angeles County before 1996 do not appear to have been effective in reducing the rate of childhood drowning in residential pools. Possible reasons for this ineffectiveness are insufficient building codes for isolating pools from homes, inadequate enforcement of the ordinances, and inadequate operation or maintenance of fencing equipment by pool owners.

Age Distribution↗
PubMed1985

Accidental drownings in Auckland children.

We consider the circumstances surrounding 60 consecutive cases of accidental drowning of children in the Auckland coronial district. More deaths occurred around the home than anywhere else. Forty-one of the fatalities occurred around the home with only two being over the age of six years. The unfenced or inadequately fenced domestic swimming pool was the most common hazard. The household bath and partly filled buckets represent further although less frequent dangers. The study reaffirms the need for legislation making the fencing of domestic swimming pools mandatory. Elsewhere, young children playing in or near water need constant supervision. More victims received either no resuscitation or inadequate resuscitation until an ambulance crew arrived at the home. This further emphasises the value of a sound knowledge of cardiopulmonary resuscitation techniques in the general population.

Accident Prevention↗
PubMed1984

The exposure of pre-school children to water hazards and the incidence of potential drowning accidents.

Pre-school drownings are a common cause of death and nearly all occur within the child's everyday environment. This study is the first attempt to (a) determine the rate of exposure of a nationwide sample of 8430 New Zealand children aged 1-3 years, to water hazards in their everyday environment and (b) obtain the number of potential drowning accidents suffered by the sample since birth. Sixty percent of the children were exposed to one and usually several, water hazards. Domestic swimming pools were the single most common hazard (39%). Sixty-three percent of these pools had no safety features. Eight-eight percent of the children's parents supported the mandatory fencing of domestic pools. Since birth, 734 of the children had experienced a total of 867 water accidents where but for a chance finding drowning could have resulted. Medical treatment was sought for 10%. Forty-eight percent occurred in a bath or a domestic swimming pool.

Accident Prevention↗
PubMed1985

Experiences with bacteriological monitoring of pool water.

A bacteriological study was completed on pools and whirlpools operated by hotels and private health clubs in the metropolitan area of Toronto, Ontario, Canada. Coliform bacteria, fecal coliform bacteria, and fecal streptococci were found only when other indices showed a drastic deterioration in water quality. Aerobic plate counts were higher, and staphylococci and Pseudomonas aeruginosa occurred more often in whirlpools than in swimming pools. There was a correlation between aerobic plate counts and the presence of staphylococci and P. aeruginosa. P. aeruginosa was rare in swimming pools in the absence of staphylococci; however, in whirlpools the organism was often found in the absence of staphylococci, and when aerobic plate counts were low. P. aeruginosa and plate counts in excess of 3,000 per ml occurred more frequently in whirlpools when the free chlorine residual was less than one part per million. The surface film showed concentrations of staphylococci far greater than the pool water. Whirlpools appear to present a different ecosystem that favors the establishment of P. aeruginosa. Staphylococci, but not Staphylococcus aureus, are useful in indicators of pool water quality but better laboratory methodology is required. Additional attention should be directed to the bacteriology of the water surface film, which presents a more direct hazard to bathers.

Bacteriological Techniques↗
PubMed1988

Virucidal effect of chlorinated water containing cyanuric acid.

The inhibitory influence of cyanuric acid on the virucidal effect of chlorine was studied. The time required for 99.9% inactivation of ten enteroviruses and two adenoviruses by 0.5 mg/l free available chlorine at pH 7.0 and 25 degrees C was prolonged approximately 4.8-28.8 times by the addition of 30 mg/l cyanuric acid. Comparative inactivation of poliovirus 1 by free available chlorine with or without cyanuric acid revealed the following. The inactivation rate by 1.5 mg/l free available chlorine with 30 mg/l cyanuric acid or by 0.5 mg/l free available chlorine with 1 mg/l cyanuric acid was slower than by 0.5 mg/l free available chlorine alone. Temperature and pH did not affect the inhibitory influence of cyanuric acid on the disinfectant action of chlorine. In the swimming-pool and tap water, cyanuric acid delayed the virucidal effect of chlorine as much as in the 'clean' condition of chlorine-buffered distilled water. The available chlorine value should be increased to 1.5 mg/l when cyanuric acid is used in swimming-pool water.

Adenoviridae↗