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PubMed1993

Microbiological quality of recreational waters in Araraquara, SP, Brazil.

The microbiological flora of 108 water samples was explored to evaluate the role of recreational waters as a possible source of human diseases in Araraquara, S.P., Brazil. These waters included six swimming pools and three lakes with beaches. The number of total and fecal coliforms, Escherichia coli, fecal streptococci, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans, and heterotrophic organisms was determined. As was the occurrence of Salmonella, Shigella, yersinia, enteropathogenic E. coli (EPEC), enteroinvasive E. coli (EIEC), Mycobacteria, yeasts in general and dermatophytes. Shigella, Yersinia, EIEC and dermatophytes were not isolated. Other organisms or groups of microorganisms were found in variable proportions. From this study it is concluded that recreational waters used by the population of Araraquara, may be contaminated with potentially pathogenic microorganism and this may serve as a source of human diseases.

Brazil↗
PubMed1991

Behavioral community intervention to reduce the risk of skin cancer.

Peer leader modeling, posted feedback, posted goals, and a commitment raffle were used at two swimming pools to increase behaviors associated with skin cancer prevention. During the intervention condition, pool lifeguards modeled the protective behaviors by wearing sunglasses, t-shirts, and hats, using zinc oxide and sunscreen, and staying in the shade. Children and adolescents (1 to 16 years old) increased their use of two or more protective behaviors from a baseline mean of 6.5% to 26.9% during the intervention. Adults (older than 16 years) increased their protective behaviors from a baseline mean of 22% to 37.95% during the intervention. The lifeguards increased their use of all the protective behaviors from a baseline mean of 16.7% to 63.5% during intervention. Ways to improve and expand this intervention are discussed.

Adolescent↗
PubMed1974

Control of tinea pedis in a swimming bath.

Random samples of the weekly entry of bathers to a swimming pool were examined for tinea pedis and verruca before and at intervals after the supply of individual sachets of foot powder to all bathers.Over three and a half years the overall incidence of tinea pedis decreased from 8.5% to 2.1%, and in adult males it decreased from 21.5% to 6.9%. The incidence of infection with Trichophyton mentagrophytes var. interdigitale decreased from 5.3% to 0.5%, and the incidence of infection with T. rubrum (1.2%-1.1%) and Epidermophyton floccosum (0.9%-0.5%) did not change significantly. The incidence of verruca decreased from 4.8% to 1.2%. Issuing foot powder clearly minimizes the spread of infection and is recommended for general use.

Administration, Topical↗
PubMed1998

Simulated front crawl swimming performance related to critical speed and critical power.

PURPOSE: Competitive pool swimming events range in distance from 50 to 1500 m. Given the difference in performance times (+/- 23-1000 s), the contribution of the aerobic and anaerobic energy systems changes considerably with race distance. In training practice the regression line between swimming distance and time (Distance = critical velocity x time + anaerobic swimming capacity) is used to determine the individual capacity of the aerobic and anaerobic metabolic pathways. Although there is confidence that critical velocity and anaerobic swimming capacity are fitness measures that separate aerobic and anaerobic components, a firm theoretical basis for the interpretation of these results does not exist. The purpose of this study was to evaluate the critical power concept and anaerobic swimming capacity as measures of the aerobic and anaerobic capacity using a modeling approach. METHODS: A systems model was developed that relates the mechanics and energetics involved in front crawl swimming performance. From actual swimming flume measurements, the time dependent aerobic and anaerobic energy release was modeled. Data derived from the literature were used to relate the energy cost of front crawl swimming to swimming velocity. A balance should exist between the energy cost to swim a distance in a certain time and the concomitant aerobic and anaerobic energy release. The ensuing model was used to predict performance times over a range of distances (50-1500 m) and to calculate the regression line between swimming distance and time. RESULTS AND CONCLUSIONS: Using a sensitivity analysis, it was demonstrated that the critical velocity is indicative for the capacity of the aerobic energy system. Estimates of the anaerobic swimming capacity, however, were influenced by variations in both anaerobic and aerobic energy release. Therefore, it was concluded that the anaerobic swimming capacity does not provide a reliable estimate of the anaerobic capacity.

Adolescent↗
PubMed2006

Human adenoviruses in water: occurrence and health implications: a critical review.

Adenoviruses are important human pathogens that are responsible for both enteric illnesses and respiratory and eye infections. Recently, these viruses have been found to be prevalent in rivers, coastal waters, swimming pool waters, and drinking water supplies worldwide. United Sates Environmental Protection Agency (USEPA) listed adenovirus as one of nine microorganisms on the Contamination Candidate List for drinking water because their survival characteristic during water treatment is not yet fully understood. Adenoviruses have been found to be significantly more stable than fecal indicator bacteria and other enteric viruses during UV treatment. Adenovirus infection may be caused by consumption of contaminated water or inhalation of aerosolized droplets during water recreation. The goal of this review is to summarize the state of technology for adenovirus detection in natural and drinking waters and the human health risk imposed by this emerging pathogen. The occurrence of these viruses in natural and treated waters is summarized from worldwide reports.

Adenoviridae Infections↗
PubMedDate not supplied

Drowning and near-drowning in Northern Territory children.

OBJECTIVE: To compare incidences of drowing for children in the Northern Territory (NT) with those in Queensland and the rest of Australia. DESIGN: Descriptive, retrospective, population-based analysis of death and hospitalisation data for drowning and near-drowning. SETTING AND PARTICIPANTS: Children aged 0-14 years resident in Australia from 1983 to 1998. MAIN OUTCOME MEASURES: Age-standardised average annual incidence of drowning (1983-1998) and near-drowning (1994-1997) in children aged 0-4 and 5-14 years in the NT, Queensland and the rest of Australia. RESULTS: The average annual incidence of drowning and near-drowning from 1994 to 1997 for children aged 0-4 years in the NT (67.82 per 100,000) was significantly higher than for Australia (24.45 per 100,000) (incident rate ratio [IRR], 2.77; 95% CI, 1.40-4.91) and for Queensland (32.55 per 100,000) (IRR, 2.13; 95% CI, 1.05-3.94). The proportion of children aged 0-4 years drowning or near-drowning in swimming pools from 1994 to 1997 was also significantly higher in the NT (83%) than Australia (64%) (difference, 0.19; 95% CI, 0.086-0.30) and Queensland (65%) (difference, 0.18; 95% Cl, 0.069-0.29). From 1983 to 1998, the incidence of drowning in NT children aged 0-4 years increased by 0.4% per year (IRR, 1.004; 95% Cl, 0.994-1.070), compared with a 5.0% reduction per year (IRR, 0.950; 95% Cl, 0.937-0.963) in Australian children. CONCLUSIONS: The incidences of drowning and near-drowning in the NT are higher than in the rest of Australia and show no significant decrease. The NT should improve its measures for prevention of childhood drowning.

Adolescent↗
PubMed1987

The effect of water exercise therapy given to patients with rheumatoid arthritis.

It is well known that patients suffering from rheumatoid arthritis have a reduced muscular function. The positive effect of physical training on rheumatic patients has been shown. In this study the effect of exercise therapy performed in a heated swimming pool has been evaluated for eight patients in a non-acute stage of rheumatoid arthritis. The median pre-treatment maximal isometric and isokinetic quadriceps strength was 88 Nm (44-146) and 99 Nm (62-149) respectively, which was 61% and 70% of that found in a control group of healthy persons. After 2 months exercise therapy the median maximal isometric and isokinetic quadriceps strength increased by 38% and 16% compared to the pre-treatment value (p less than 0.02 and p less than 0.05). All patients, except one who developed cardiac arrhythmia during the second test, accomplished a submaximal bicycle test (a.m. Astrand). An increase in the aerobic capacity was observed in all patients after the training period.

Adult↗
PubMed1995

Water safety training as a potential means of reducing risk of young children's drowning.

OBJECTIVES: To determine the effects of training in swimming and water safety on young preschool-children's ability to recover safely from a simulated episode of falling into a swimming pool. DESIGN: Randomized trial of 12 or eight weeks' duration water safety and swimming lessons for children 24 to 42 months old. OUTCOME MEASURES: Swimming ability, deck behavior, water recovery, and swimming to side after jumping into pool were measured before, during, and after the training program. RESULTS: 109 children completed the study (61 in the 12 week group, 48 in the eight week group). The average age was 34.2 months, 54% were male. Swimming ability, deck behavior, water recovery, and jump and swim skills improved over baseline levels in both groups. By the end of training, the 12 week group improved more than the eight week group only in swimming ability. Improvements in water recovery and jump and swim skills were associated positively with changes in swimming ability. CONCLUSIONS: Swimming ability and safety skills of young preschool children can be improved through training. Such programs may offer some protection for children at risk of drowning and there was no indication that this program increased the risk of drowning. However, pool fencing, other barriers around water, and parental supervision still remain the most important prevention strategies to reduce drowning in young children.

Accidental Falls↗
PubMed2005

[Pathogenic properties of free-living amoebae isolated from natural and man-made bathing sites in the province of Western Pomerania].

INTRODUCTION: Pathogenic amoebae belonging to the genus of Acanthamoeba and Naegleria, as well as species such as Balamuthia mandrillaris and Sappinia diploidea cause harmful, life-threatening infections in humans and animals. These amoebae commonly occur in the natural environment. Free-living, pathogenic amoebae have hitherto been detected in water reservoirs near Poznań, Gdańsk, and Lublin. MATERIAL AND METHODS: The present work focused on the occurrence of thermophilic amoebae potentially pathogenic to humans. Natural and man-made bathing sites in the province of Western Pomerania were studied. A total of 299 water samples were collected between 2001 and 2003 from 86 sites (indoor swimming pools, seasonal pools, physiotherapy pool, fountains, lakes, ponds, rivers, lagoons, and coastal waters of the Baltic Sea). Amoebae were isolated at 37 degrees C from 223 samples, of which 34 (15.2%) demonstrated thermophilic properties. Tests using thermophilic isolates were carried out on mice through intranasal inoculation. Pathogenic properties and intensity of infection were determined on the basis of re-isolation of amoebae from agar substrates inoculated with fragments of internal organs. Organs of infected mice were examined histologically. RESULTS: Six isolates exhibited infective properties in mice. Five of them were obtained from two man-made water reservoirs belonging to the recreational complex of the city of Szczecin (AM 17, AM 148, AD 16, AD 148, AD 166). One isolate was from a natural reservoir (JG 172). Amoebae were isolated from the brain, lungs, liver, kidneys, spleen, and heart of the infected animals.

Amoeba↗
PubMed1983

Pseudomonas aeruginosa serotype 0:9. New cause of whirlpool-associated dermatitis.

In a five-day period, dermatitis developed in nearly one fourth of the guests staying at a large Georgia hotel. Dermatitis was associated with use of the hotel's whirlpool (p less than 0.001) and indoor swimming pool (p less than 0.001). Attack rates were highest among persons more frequently exposed to the whirlpool, in persons under 10 years of age, and during periods of heaviest bather load. Pseudomonas aeruginosa was isolated from skin lesions of 13 of 20 patients from whom culture specimens were taken. Ten isolates were serotype 0:9. The whirlpool's water grew P. aeruginosa serotype 0:9; however, the whirlpool's automatic chlorinator was functioning properly, the pH of the water was 7.2, and the free chlorine level was 0.6 mg/liter. This is the first report of a whirlpool-associated outbreak caused by P. aeruginosa serotype 0:9. Our findings suggest that this strain may not be readily sensitive to recommended chlorine concentrations.

Adolescent↗
PubMed1980

Who accepts first aid training?

The percentage of individuals trained in first aid skills in the general community is inadequate. We report here a study to investigate factors which influence motivation to accept voluntary training in first aid. A group of 700 randomly selected owners of inground swimming pools (a parental high-risk group) was offered a course of formal first aid instruction. Nine per cent attended the offered training course. The time commitment involved in traditional courses (eight training nights spread over four weeks) is not a deterrent, the same percentage accepting such courses as that who accept a course of one night's instruction. Cost is an important deterrent factor, consumer resistance rising over 15 cost units (one cost unit = the price of a loaf of bread). The level of competent first aid training within the community can be raised by (a) keeping to traditional course content, but (b) by ensuring a higher acceptance rate of first aid courses by a new approach to publicity campaigns, to convince prospective students of the real worth of first aid training. Questions concerning who should be taught first aid, and factors influencing motivation, are discussed.

Adult↗
PubMed2003

Epidemiological typing of Acanthamoeba strains isolated from keratitis cases in Belgium.

From the corneas of nine keratitis patients and from their contact lenses, contact lens boxes and saline solutions, 15 strains of Acanthamoeba have been isolated. An Acanthamoeba strain was isolated from the swimming pool where one of the patients swam, while in the tapwater of the houses of three patients investigated, no Acanthamoeba could be detected. All the Acanthamoeba isolates from the cornea belong to genotype T4, but are different subtypes of T4. The Acanthamoeba detected on the contact lenses (and/or associated paraphernalia) of a patient are of the same subtype as that isolated from the cornea. The only Acanthamoeba strain isolated from a contact lens which was not related to an Acanthamoeba keratitis infection proved to be another genotype. A strain of Hartmannella from a cornea and two vahlkampfiids isolated from contact lenses had no connection with keratitis. This study confirms that, as found elsewhere, only Acanthamoeba genotype T4 of the 12 known Acanthamoeba genotypes is responsible for keratitis in Belgium. Most cases of Acanthamoeba keratitis cases are due to poor hygiene in the treatment (cleaning and storage) of contact lenses.

Acanthamoeba↗
PubMed2001

Molecular detection of Campylobacter spp. in drinking, recreational and environmental water supplies.

A molecular detection assay was performed on 207 samples of drinking, recreational and environmental waters collected in Northern Ireland. The water sources which were PCR positive for Campylobacter spp. included 2/91 (2.2%) drinking water from domestic household taps, 5/57 (8.8%) swimming pool water, 1/23 (4.3%) lake water and 1/1 water from a jacuzzi. Extracted DNA from all water samples was amplified employing a sequence-specific PCR assay based on a 206 bp conserved region of the flagellin A-flagellin B (flaA/flaB) loci for Campylobacter jejuni, C. coli and C. lari. Given the physiological and cultural fragile nature of these species, no waters were cultured using conventional methods due to concern for reversion to non-culturability from time of collection to laboratory analysis. As this genus has been demonstrated to form a 'viable but non-culturable' (VBNC) form, failure to culture organisms conventionally from water does not necessarily equate to a negative result, hence molecular detection assays, especially those which can demonstrate cell viability, may be useful in helping to elucidate potential epidemiological sources and reservoirs of this organism, especially where water is suspected as being the vehicle of transmission.

Anti-Bacterial Agents↗
PubMed2003

Acute schistosomiasis outbreak in the metropolitan area of Belo Horizonte, Minas Gerais: alert about the risk of unnoticed transmission increased by growing rural tourism.

The present article describes the occurrence of 17 cases of acute schistosomiasis in the metropolitan area of Belo Horizonte, state of Minas Gerais, Brazil. All individuals affected took a bath in a swimming pool of a holiday resort that was provided with water from a nearby brook. The apparently clean water and the absence of snails in the pool gave the wrong impression that there was no risk for infection. During a malacological survey at the site snails of the species Biomphalaria glabrata were found and tested positive for Schistosoma mansoni. All the patients live in the middle-class area of Barreiro, metropolitan area of Belo Horizonte and have medium grade school education. The difficulties in establishing the right diagnosis is expressed by the search for medical attention in 17 different medical facilities, the wide range of laboratory test and the inadequate treatment administration. A lack of knowledge about the disease was found in all groups studied. The booming rural tourism in endemic areas is identified as a probable risk factor for infection, especially for individuals of the non-immune middle and upper class parts of the society in urban centers. Special attention is given to a multidisciplinary approach to the complex issue of disease control and prevention.

Acute Disease↗
PubMed2004

Rural tourism as risk factor for the transmission of schistosomiasis in Minas Gerais, Brazil.

Recently, the booming rural tourism in endemic areas of the state of Minas Gerais was identified as a contributing factor in the dissemination of the infection with Schistosoma mansoni. This article presents data from six holiday resorts in a rural district approximately 100 km distant from Belo Horizonte, MG, Brazil, where a possibly new and until now unperceived way of transmission was observed. The infection takes place in swimming pools and little ponds, which are offered to tourists and the local population for fishing and leisure activities. The health authorities of the district reported cases of schistosomiasis among the local population after visiting these sites. As individuals of the non-immune middle class parts of the society of big urban centers also frequent these resorts, infection of these persons cannot be excluded. A malacological survey revealed the presence of molluscs of the species Biomphalaria glabrata and Biomphalaria straminea at the resorts. The snails (B. glabrata) of one resort tested positive for S. mansoni. In order to resolve this complex problem a multidisciplinary approach including health education, sanitation measures, assistance to the local health services, and evolvement of the local political authorities, the local community, the tourism association, and the owners of the leisure resorts is necessary. This evidence emphasizes the urgent need for a participative strategic plan to develop the local tourism in an organized and well-administered way. Only so this important source of income for the region can be ensured on the long term without disseminating the disease and putting the health of the visitors at risk.

Animals↗
PubMedDate not supplied

[Current status of bath water treatment techniques].

The Federal German DIN standard No. 19644 that has been enforced in West Germany since 1989 had to be revised in view of the fact that German legislation is expected to issue an ordinance on swimming pool and public bath water within the framework of the Federal Communicable Diseases Act; furthermore, the need for revision also arose from the solution of the hygienic problems of treatment and disinfection of warm whirlpool water, and from the necessity of modifying several now outdated regulations. It is the aim of public health legislation to prevent health risks of bathers and of attendant staff by Legionella pneumophila in all types of basins with additional water cycles and intake of air (aerosol formation); likewise, adverse health effects of side reaction products of the disinfectant chlorine (i. e. chloroamines and halogenated organic compounds, especially the trihalomethanes) must be avoided. Recent research has shown that these aims can be achieved by altering the mode of running and backwashing filters of all process combinations including those using ozone and introducing an additional absorption on powdered activated carbon, and the process combination of flocculation-filtration-chlorination. Improved treatment would be without effect if turnover rates could not be assessed reliably for basins of irregular geometry--as they are preferably used today--operated with additional water cycles involving intake of air. Lack of costly investigations prompts users to estimate turnover rates on the basis of experience collected with basins of square or rectangular dimensions.

Baths↗
PubMed1992

Hypersensitivity pneumonitis: sensitivity of high-resolution CT in a population-based study.

OBJECTIVE: Hypersensitivity pneumonitis refers to a group of pulmonary disorders caused by inhalation of organic or inorganic particulates by sensitized persons. The diagnosis relies on a constellation of findings: exposure to an offending antigen, characteristic signs and symptoms, abnormal chest findings on physical examination, and abnormalities on pulmonary function tests and radiographic evaluation. In population-based studies, the sensitivity of chest radiography for detection of this disease is relatively low. The aim of this study was to determine the sensitivity of high-resolution CT (HRCT) for detection of hypersensitivity pneumonitis diagnosed in a population of swimming-pool employees. SUBJECTS AND METHODS: Thirty-one symptomatic employees of a recreation center who were referred because of possible hypersensitivity pneumonitis were examined by using chest radiography, HRCT, and fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. Hypersensitivity pneumonitis was diagnosed in subjects who had two or more work-related signs or symptoms, abnormal results on transbronchial biopsies, and abnormal lymphocytosis as shown by examination of bronchoalveolar lavage fluid. The chest radiographs and HRCT scans were interpreted by consensus by two observers who were unaware of the clinical diagnosis. RESULTS: Only one of 11 subjects with a diagnosis of hypersensitivity pneumonitis had abnormal findings on a chest radiograph. Five had abnormal HRCT findings. The abnormality in each case consisted of small, poorly defined centrilobular nodules with variable profusion. No subject without the disease had abnormal HRCT findings. Those who had granulomas shown by lung biopsy were more likely to have abnormal HRCT findings than were those who had more subtle histologic abnormalities. CONCLUSION: The sensitivity of HRCT for the detection of hypersensitivity pneumonitis in a population-based study is greater than that of chest radiography. The finding of poorly defined centrilobular nodules on HRCT scans should prompt consideration of this disease.

Adolescent↗
PubMed2006

Management of environmental health issues for the 2004 Athens Olympic Games: is enhanced integrated environmental health surveillance needed in every day routine operation?

BACKGROUND: Management of environmental health issues is an integral part of public health systems. An active integrated environmental health surveillance and response system was developed for the Athens Olympics to monitor and prevent exposure to environmental hazards. The potential for permanent implementation of the program was examined. METHODS: The environmental health surveillance and response system included standardization, computerization and electronic transmission of data concerning environmental inspections of 17 site categories (restaurants, swimming pools etc) of public health interest, drinking and recreational water examinations and suggested corrective actions. The Olympic Planning Unit integrated and centrally managed data from 13 public health agencies, recommended, supervised and coordinated prompt corrective actions. Methods used to test the effectiveness of the program were the assessment of water quality test and inspection results trends over time using linear regression and epidemiological surveillance findings. RESULTS: Between January 2003 and September the 30th, 2004, 196 inspectors conducted 8562 inspections, collected 5024 water samples and recommended 17 027 corrective actions. In 10 cruise ships used as floating hotels inspectors conducted 10 full inspections, 2 re-inspections, and 27 follow-up inspections. Unsatisfactory inspection results (r = 0.44, p < 0.0001) and positive water quality tests (r = 0.39, p < 0.001) presented an overall decrease trend over time. In August, 2003, an outbreak of salmonellosis was linked to a hotel restaurant which accommodated athletes during a test event. CONCLUSION: Lessons learned for future events include timely implementation and installation of communication processes, and rapid and coordinated response to unsatisfactory inspection results. Routine national programs need to adopt enhanced environmental health surveillance aimed at public health decision-making, but with a different perspective.

Accident Prevention↗