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Nosocomial outbreak of Pseudomonas aeruginosa folliculitis associated with a physiotherapy pool.

Outbreaks of community-acquired Pseudomonas aeruginosa folliculitis have recently been described in association with health spa whirlpools. In February 1984 we detected an outbreak of Pseudomonas folliculitis among hospital staff and patients using a swimming pool in a newly constructed physiotherapy unit. A rash developed in 5 (45%) of the 11 physiotherapists who had used the pool, as compared with 0 of the 17 who had not (p less than 0 005). Pseudomonas folliculitis also developed in 6 (21%) of 29 outpatients and 4 (33%) of 12 inpatients who had used the facility; Pseudomonas infection of a surgical wound also developed in 1 of the 4 inpatients. The epidemic curve was consistent with a continuing common-source outbreak. P. aeruginosa, serotype O:10, was isolated from three physiotherapists, the patient with an infected surgical wound and the pool. A case-control study of pool users did not identify risk factors for infection, although the physiotherapists had spent longer in the pool than had the patients. After hyperchlorination and structural repairs to the pool, no further cases were identified among pool users. This outbreak is the first reported nosocomial outbreak of Pseudomonas folliculitis. Further investigation is needed to determine the risk of serious Pseudomonas infections in hospitalized patients using physiotherapy pools.

Adult↗

Amoebic meningoencephalitis: 16 fatalities.

The parasitologic examination of pathologic brain tissue from 16 cases of acute plurulent meningoencephalitis occurring between 1962 and 1965 in northern Bohemia disclosed massive infection of the central nervous system by amoebas of the limax type. The common source was an indoor swimming pool.

Adolescent↗

Sensitive headspace gas chromatography-mass spectrometry determination of trihalomethanes in urine.

A sensitive and straightforward method for the determination of trihalomethanes (THMs) in urine by using headspace extraction technique has been developed. Chemical and instrumental variables were studied in order to optimize the method for sensitivity: an excess of KCl (4 g per 12 ml of urine), an oven temperature of 85 degrees C and an equilibration time of 30 min were selected. The use of the mass spectrometer in selected ion monitoring mode allows achieving linear ranges between 10 and 5000 ng/l and detection limits from 3 to 10 ng/l, for 12 ml of urine. The stability of the urine sample during storage at 4 and -20 degrees C was also evaluated: THMs remained stable for up to 2 days and 2 months, respectively. Finally, the method was successfully applied to study the THM uptake from swimmers of an indoor swimming pool, as well as non-swimmers. This study revealed that the concentrations of THMs in urine increased approximately three times for chloroform and bromodichloromethane after swimming activity. In addition, THMs in unchanged form were mainly excreted within 2-3h after the end of exposure.

Chloroform↗

Lifeguards' vigilance: effects of child-adult ratio and lifeguard positioning on scanning by lifeguards.

Observers recorded visual scanning by four lifeguards at three indoor public swimming pools. Scanning increased as a positive function of the ratio of children to adult swimmers, i.e., scanning was greater when the ratio was high, suggesting that lifeguards became more concerned about the risks to children and the ability of nearby adult swimmers to monitor these children when the number of children significantly exceeded the number of adults. Absolute numbers of children, however, decreased number of scans, possibly because of greater number of incidents and rule violations requiring lifeguards' attention which competed with watching the pool. Lifeguards were more likely to scan a pool area when they were in elevated towers versus standing on the pool decks. Lifeguards' scanning declined later in the day, possibly due to fatigue or because of competing activities of pool maintenance.

Adolescent↗

Epidemiology and impact of childhood molluscum contagiosum: a case series and critical review of the literature.

Parents of 30 children with clinically diagnosed molluscum contagiosum were surveyed to assess their perception of the condition, its treatment, its impact on their everyday lives, and on the children themselves. Among parents, 82% reported that molluscum contagiosum concerned them moderately or greatly. Concerns focused on physical issues associated with the infection, such as scarring, itching, chance of spread to peers, pain, and the effects of treatments. Quality of life was not affected. Molluscum contagiosum was most common among school-age children. Eighteen of 29 respondents swam in public pools, a common activity in children of this age. All epidemiologic studies of molluscum contagiosum in otherwise healthy individuals, published since 1966, have been critically reviewed herein. The review confirms an association between swimming pool use and molluscum contagiosum. Age, living in close proximity, skin-to-skin contact, sharing of fomites, and residence in tropical climates were also associated with higher rates of infection while sex, seasonality, and hygiene showed no such association.

Attitude to Health↗

Swimming and the risk of cutaneous melanoma.

Recreational exposure to the sun may not explain fully current trends in melanoma incidence. The hypothesis was examined whether carcinogens in water play a role in the development of cutaneous melanoma. In a case-control study, 128 melanoma patients and 168 patients with other types of malignancy completed a detailed questionnaire on aquatic leisure time activities. All relative risk estimates were adjusted for age, gender, educational level, pigmentation characteristics, and exposure to sun habits. Regular swimming during the summer months in swimming pools and in open waters such as rivers and seas before the age of 15 years, was associated with odds ratios of 2.20 (95% confidence interval (CI), 1.05-4.62) and 2.41 (95% CI, 1.04-5.58), respectively, compared with no swimming at all or swimming in relatively unpolluted waters, such as lakes and fens. Melanoma patients learned to swim at a younger age; compared with those who never learned to swim or who learned to swim after the age of 12 years, the odds ratio was 1.87 (95% CI, 0.91-3.78) for those who learned to swim at ages 9-12 years, and 2.22 (95% CI, 1.16-4.26) for those who learned to swim before 9 years of age. Compared with persons who had no swimming certificates, an odds ratio of 1.25 (95% CI, 0.71-2.23) was found for persons with one or two certificates, and an odds ratio of 2.96 (95% CI, 1.25-6.96) for persons with three or more certificates. The positive association between a history of swimming and melanoma risk suggests that carcinogenic agents in water, possibly chlorination by products, play a role in melanoma aetiology.

Adolescent↗

[The diagnosis and treatment of mixed anaerobic vaginal dischargs (authors' transl)].

In about 5% of 3355 patients the microscopic examination of the vaginal discharge in normal saline showed a characteristic fast moving rod. More than 80% of these patients complained of a discharge with a foul smell during the menstrual period. Bactriology showed an anaerob gram negative rod which was difficult to grow and is as yet unclassified. Following treatment with one gram of Mimorazol every 12 hours for 3 doses, 71,5% of the patients were cured and showed a normal vaginal flora without further treatment. In around 24,13% of the patients the gram negative rod disappeared but a persistent mixed flora required further treatment. In 4.3% of the patients a recurrence occurred. An attempt was made to prevent recurrent infection prior to the follow-up examination by prohibition of sexual intercourse with an untreated partner, bathing in public swimming pools, and the use of sponges or wash cloths. In the course of the investigation the suspicion of contamination from the water of public pools became apparent. The diagnosis, treatment and transmission and the pathogenecity of the fast moving negative rod is discussed.

Female↗

[Oxygen consumption of the Baikal seal during unrestrained swimming in a pool and diving of different duration].

In 7 male Baikal seals (14-49 kg) spending 60-90% of the time under water, swimming unrestrained in the swimming pool, the average VO2 ranged from 8.6 +/- 7.01 ml (kg min)-1 for a 14-kg seal up to 4.8 +/- 2.22 ml (min kg)-1 (+ sigma) for adult 49-kg seal. A short forced diving (3-5 min) induced no change of the VO2 level because of stored oxygen. More prolonged diving (10-30 min) induced a 2-3-fold reduction of general VO2 and accumulation of a considerable O2-dept. During 3-5 min, 50-80% of this debt is covered in the 1st phase of recovery. The rest of the debt is covered during 10-40 min, depending on diving duration, body mass and, probably, oxidizing of metabolites of anaerobic exchange.

Animals↗

[On the determination of chlorine with a polarographic probe. 2nd communication: experimental arrangement and results under application (author's transl)].

The examination of the physical properties of the instrument showed several possibilities of meter-error mainly due to constructive disadvantages. After having found this a special experimental arrangement was worked out to exclude errors. Then good linear correlations of the meter-reading and the analytical DPD-Method for free Chlorine were found for pH-values ranging from 3.7 to 11. Further the results of a test under practical conditions in a swimming pool are shown and the possibility to discriminate different types of waters by their chlorine demand under constant-titration.

Chlorine↗

Development and validation of AIMFREE: Accessibility Instruments Measuring Fitness and Recreation Environments.

PURPOSE: The purpose of this study was to develop and validate a series of 16 survey instruments measuring fitness and recreation accessibility, collectively referred to as AIMFREE (Accessibility Instruments Measuring Fitness and Recreation Environments). General domains of assessment included the built environment, equipment, programmes, policies, and training and behaviour. METHODS: Fitness and recreation professionals (n=35) assessed fitness centres/swimming pools (n=35) in nine regions across the US. Rasch analysis was used to assess the psychometric properties of the instrument. RESULTS: The AIMFREE evidenced adequate to good fit to the Rasch model and adequate to good internal consistency (r=0.70 - 0.90). Test-retest reliability ranged from 0.70 (entrance areas) to 0.97 (swimming pools). Analysis of differential item functioning indicated that item calibrations generally did not differ significantly between urban and suburban environments. CONCLUSION: The AIMFREE instruments demonstrated adequate to good fit to the Rasch model with several of the subscales demonstrating well to excellent separation of facility accessibility.

Architectural Accessibility↗

Swimming in chlorinated water and its effect on Eustachian tube function.

Middle-ear effusion in children is considered to be the result of multiple factors. Swimming in chlorinated water has been incriminated as one such possible aetiological factor. To test the hypothesis that the chemical disinfectant in the swimming pool is probably responsible for the Eustachian tube dysfunction, 30 children between the ages of four and eight years were selected at random from the community health department computer records and were randomly allocated into two groups. Eustachian tube function was assessed by standard tympanometry both immediately prior to swimming (control) and 30 to 45 minutes following swimming in Group 1 and approximately 14 hours following swimming in Group 2. The results of the study showed no significant change (p greater than 0.05) between pre- and post-swimming tympanometry. It is therefore concluded that swimming on the surface of chlorinated water does not compromise the Eustachian tube function in children with healthy middle ears.

Acoustic Impedance Tests↗

Child and adolescent drownings in Harris County, Texas, 1983 through 1990.

OBJECTIVES: This study described childhood drowning rates and circumstances in Harris County, a large metropolitan area in Texas, and compared case ascertainment between data sources. METHODS: Drowning rates among Harris County residents newborn through 19 years of age were calculated from death certificate data (1983 through 1989), and local childhood drowning hazards were described on the basis of medical examiner data (1983 through 1990). Cases from both sources were compared to determine sensitivity of sources. RESULTS: The drowning rate among Harris County residents newborn through 19 years of age was 3.8 per 100,000 person-years. The drowning rates among Blacks and Hispanics exceeded that of Whites by 56% and 19%, respectively. The majority of the 196 unintentional drownings occurred in swimming pools. Half of the pool drownings occurred in apartment pools and 33% in private home pools. The medical examiner logbook identified a slightly higher number of drownings than did death certificates. International Classification of Diseases external cause of death codes were of limited use in describing drowning circumstances. CONCLUSIONS: Childhood drowning hazards not previously reported were identified, specifically hazards in apartment pools and those among Hispanic children.

Adolescent↗

Nasal changes following immersion in chlorinated water.

Ten swimmers had rhinomanometry, mucociliary clearance time and lung function tests performed pre and post swimming in a chlorinated swimming pool. No evidence of nasal irritation or adverse effects on nasal function were obtained.

Adolescent↗

Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review.

An outbreak of folliculitis caused by Pseudomonas aeruginosa serotype O:7 occurred among the guests of a hotel in St. John's, Newfoundland, Canada, and the source of the infection was traced to the hotel whirlpool. Of 36 persons who used the whirlpool, 26 (72%) developed folliculitis within 1 to 5 days after exposure; the attack rate was significantly higher for children (90%) than for adults (50%). The rash characteristics were consistent with those of Pseudomonas folliculitis previously described (T. L. Gustafson, J. D. Band, R. H. Hutcheson, Jr., and W. Schaffner, Rev. Infect. Dis. 5:1-8, 1983). This is considered to be the first outbreak in which P. aeruginosa serotype O:7 has been incriminated. Published reports to date of outbreaks of Pseudomonas folliculitis associated with the use of whirlpools, hot tubs, swimming pools, etc., were reviewed.

Adolescent↗

The epidemiology of drowning in Cape Town--1980-1983.

The results of a 4-year retrospective study on the epidemiology of drowning in greater Cape Town are presented. With rates corrected to per 100 000 population, the highest incidences of drowning were found to be in white children and adult black males. The commonest sites of drowning were the coastline and harbours of greater Cape Town. The majority of adult drownings were associated with positive blood alcohol tests (64,6%) and in the case of black men occurred while at work. The majority of drownings in children occurred in home swimming pools.

Accidents↗

Wild water rapid burns.

Swimming pool water slides are becoming increasingly long and adventurous. This case report and survey suggest that they may carry with them a notable risk of friction burns.

Adult↗

Brain-reactive antibodies and behavior of autoimmune MRL-lpr mice.

The hypothesis that brain-reactive autoantibodies (BRA) impair behavior was examined in MRL-lpr mice, which develop spontaneous autoimmune disease. Circulating BRA were measured as in vitro serum reactivity to Neuro-2A neuroblastoma cell line, and behavioral competence was assessed in activity monitors, open field, beam walking, and Morris water maze task. Mice with BRA in serum (BRA positive) exhibited slower spontaneous locomotion in a novel environment, shorter grooming episodes, and less exploration of the open field centre when compared to age-matched 7-11-week-old BRA-negative cagemates. Moreover, when initially exposed to the large swimming pool, BRA-positive mice showed increased swimming along the wall, but had no difficulty in learning the water maze task or in traversing a narrow beam. Brain-reactive autoantibodies titre and behavioral measures were not correlated, suggesting that the concentration of serum BRA is not reflective of the magnitude of behavioral impairment. Nevertheless, the present study suggests that the presence of circulating BRA is associated with impaired exploration and/or enhanced emotional reactivity in MRL-lpr mice. It also supports the hypothesis of a pathogenic role of BRA in various mental disorders.

Animals↗

Measurement of trihalomethanes in potable and recreational waters using solid phase micro extraction with gas chromatography-mass spectrometry.

Solid phase micro extraction (SPME) was applied to the determination of selected trihalomethanes (THMs), chloroform, bromodichloromethane, dibromochloromethane, bromoform, in potable and recreational waters. The selected samples were environmentally significant due to mandatory limits imposed by regulatory agencies. Extraction of the analytes was performed using headspace SPME (fused silica fibre with a 100 microm poly(dimethylsiloxane coating) followed by thermal desorption at 220 degrees C and GC-MS analysis. A linear working range of 10-160 microg/l was established with relative standard deviations (%RSD) within the range, 0.9-19%. Limits of detection (LOD) were 1.0-2.8 microg/l. The highest THM concentration was 61.8 microg/l which was well within the proposed European Union directive of 100 microg/l. The total THMs determined in swimming pool waters ranged from 105-134 microg/l, with chloroform accounting for 84-86% of total THM.

Bromine↗