Prevalence of Ocular, Respiratory and Cutaneous Symptoms in Indoor Swimming Pool Workers and Exposure to Disinfection By-Products (DBPs)

The objective of this cross-sectional study was to investigate the prevalence of self-reported respiratory, ocular and cutaneous symptoms in subjects working at indoor swimming pools and to assess the relationship between frequency of declared symptoms and occupational exposure to disinfection by-products (DBPs). Twenty indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 133 employees was collected using a self-administered questionnaire. Subjects working at swimming pools claimed to frequently experience the following symptoms: cold (65.4%), sneezing (52.6%), red eyes (48.9%) and itchy eyes (44.4%). Only 7.5% claimed to suffer from asthma. Red eyes, runny nose, voice loss and cold symptoms were declared more frequently by pool attendants (lifeguards and trainers) when compared with employees working in other areas of the facility (office, cafe, etc.). Pool attendants experienced generally more verrucas, mycosis, eczema and rash than others workers; however, only the difference in the frequency of self-declared mycosis was statistically significant (p = 0.010). Exposure to DBPs was evaluated using both environmental and biological monitoring. Trihalomethanes (THMs), the main DBPs, were evaluated in alveolar air samples collected from subjects. Swimming pool workers experienced different THM exposure levels: lifeguards and trainers showed the highest mean values of THMs in alveolar air samples (28.5 ± 20.2 μg/m3), while subjects working in cafe areas (17.6 ± 12.1 μg/m3), offices (14.4 ± 12.0 μg/m3) and engine rooms (13.6 ± 4.4 μg/m3) showed lower exposure levels. Employees with THM alveolar air values higher than 21 μg/m3 (median value) experienced higher risks for red eyes (OR 6.2; 95% CI 2.6–14.9), itchy eyes (OR 3.5; 95% CI 1.5–8.0), dyspnea/asthma (OR 5.1; 95% CI 1.0–27.2) and blocked nose (OR 2.2; 95% CI 1.0–4.7) than subjects with less exposure. This study confirms that lifeguards and trainers are more at risk for respiratory and ocular irritative symptoms and cutaneous diseases than subjects with other occupations at swimming pool facilities

The effects of effort-reward imbalance on inflammatory and cardiovascular responses to mental stress.

Objective: We examined the influence of effort-reward imbalance, a stressful feature of the work environment, on cardiovascular and inflammatory responses to acute mental stress. Methods: Ninety-two healthy men (mean age, 33.1 yeasr) in full-time employment were recruited. Effort-reward imbalance was measured using a self-administered questionnaire. Blood, for the analysis of C-reactive protein (CRP) and von Willebrand factor (vWF) antigen, was sampled at baseline and 10 minutes after two mental stress tasks, whereas cardiovascular activity was measured throughout. Results: Plasma CRP and vWF were significantly elevated following the stress period, and cardiovascular activity was increased during and after both tasks (p < .001). Multiple linear regression analysis adjusted for age, body mass index, and baseline levels revealed that men with higher effort-reward imbalance demonstrated greater CRP and vWF responses to the stress tasks but blunted cardiovascular responses. Inflammatory and cardiovascular responses to stress appeared to be unrelated. Conclusions: These findings suggest that the association between chronic work stress and cardiovascular disease risk may be mediated in part by heightened acute inflammatory responsivity. These responses appear not to result from differences in sympathoadrenal activation. ERI = effort-reward imbalance; CHD = coronary heart disease; IL = interleukin; CRP = C-reactive protein; vWF = von Willebrand factor; BMI = body mass index

The effects of effort-reward imbalance on inflammatory and cardiovascular responses to mental stress.

Objective: We examined the influence of effort-reward imbalance, a stressful feature of the work environment, on cardiovascular and inflammatory responses to acute mental stress. Methods: Ninety-two healthy men (mean age, 33.1 yeasr) in full-time employment were recruited. Effort-reward imbalance was measured using a self-administered questionnaire. Blood, for the analysis of C-reactive protein (CRP) and von Willebrand factor (vWF) antigen, was sampled at baseline and 10 minutes after two mental stress tasks, whereas cardiovascular activity was measured throughout. Results: Plasma CRP and vWF were significantly elevated following the stress period, and cardiovascular activity was increased during and after both tasks (p < .001). Multiple linear regression analysis adjusted for age, body mass index, and baseline levels revealed that men with higher effort-reward imbalance demonstrated greater CRP and vWF responses to the stress tasks but blunted cardiovascular responses. Inflammatory and cardiovascular responses to stress appeared to be unrelated. Conclusions: These findings suggest that the association between chronic work stress and cardiovascular disease risk may be mediated in part by heightened acute inflammatory responsivity. These responses appear not to result from differences in sympathoadrenal activation. ERI = effort-reward imbalance; CHD = coronary heart disease; IL = interleukin; CRP = C-reactive protein; vWF = von Willebrand factor; BMI = body mass index

Environmental monitoring of Disinfection by-products (DBPs) in water and air in indoor swimming pools

To evaluate the presence of volatile (THMs) and nonvolatile [chlorite, chlorate, bromate, haloacetic acids (HAAs)] disinfection by-products (DBPs) in indoor swimming pools.Some indoor swimming pools in Emilia Romagna region (Northern Italy) were visited and water and environmental air samples were collected. Sodium hypochlorite or dichloroisocyanurate were involved in water disinfection treatments. THMs in water and air were evaluated by head-space gas chromatographic technique, whereas HAAs, bromate, chlorite, chlorate in water were detected by ion chromatography with mass spectrophotometry.THMs were always present in pool water (range: 27-98 μg/L) and in environmental air (range: 39-119 μg/m3), with chloroform as the main by-product. Levels in air were persistent and higher above and around the pool than in the surroundings. Bromate was never found while among HAAs monochloro, dichloro, and trichloroacetic acids were measured in all water samples (range: 109-387 μg/L). Chlorite in pool water was rarely evidenced, whereas it was always present in water supplying the pool. Chlorate was present in source water and also in pool water samples showing unexpectedly high concentrations (range: 192- 12,537 μg/L), with an increase of about 50 times with respect to source water.THMs, as index of the total amount of volatile DBPs, represent an additional source of human exposure as present in water and air. Among nonvolatile DBPs, only HAAs and chlorate were detected, sometimes at very high levels. Chlorate, usually considered as a by-product when drinking water treatment is made by chlorine dioxide, seems associated with disinfection processes usually adopted for swimming pool water, such as sodium hypochlorite or dichloroisocyanurate. The origin and chemical reactions of nonvolatile DBPs deserve further evaluation to refine exposure for subjects attending indoor swimming pools

Occupational exposure in Italian swimming pools and self-reported health conditions

In indoor swimming pools both chemical substances in water and air and microclimate parameters influence health status and well-being of subjects employed in these environments. In order to investigate on the possible detrimental impacts of occupational exposure for trainers, lifeguards and facility operators 20 indoor swimming pools in Emilia Romagna have been visited in 2007 and 133 workers were enrolled in the study.Microclimate parameters (dry and radiant air temperature, air speed, relative humidity, illumination levels) were measured by a multi-data logger (BABUC A-LSI Lastem) equipped by a software (InfoGAP) aimed to calculate microclimate indices for moderate environments, taking into account personal clothing. Disinfection By Products (DBPs) such as trihalomethanes (THMs) and residual combined chlorine were evaluated in pool water: THMs were analysed in indoor air and in alveolar air samples collected from 115 workers. Head space gaschromatography was used for THMs in water samples, while THMs both in indoor air and alveolar air samples were analysed by direct injection. Information about personal data and job description was collected. Self-reported health conditions were recorded by a questionnaire: upper respiratory symptoms (runny nose, nasal obstruction, voice loss, etc), lower respiratory symptoms (wheezing, asthma, etc), ocular symptoms (itchy, red and watering eyes) and ever presence of fungal diseases, warts and dermal irritative symptoms were registered, together with self-reported information about dermal comfort/discomfort.On the whole, microclimate parameters are within the range of values suggested by the Italian guidelines for indoor swimming pools. In 19 environments (95%) illumination levels were in agreement with the above guidelines ( 65150 lux); similarly, air speed values and relative humidity levels were adequate ( 640.1 m/s and 6470% respectively) for 14 (70%) and 13 (65%) swimming pools. 14 swimming pools (70%) showed dry air temperature values lower than water temperature, and so associated with a thermal discomfort condition. The Predicted Mean Vote (PMV) is a thermal index which scores the comfort/discomfort level for workers, taking into account dry air temperature, relative humidity and air speed levels. The values showed a generally acceptable thermal condition shifted towards a warm sensation. The most prevalent health symptoms were nasal obstruction (21,1%), voice loss (17.3%) and mucosal irritative symptoms (15.8%), followed by red eyes (13.5%), itchy eyes (12.8%) and watery eyes (6%). THMs in indoor air (range: 1.7-187.5 mcg/m3) were highly correlated with THMs in alveolar air samples (range: 1.0-123 mcg/m3) (r = 0.68; P = 0.001). Chloroform, the most prevalent compound, and dichloro bromo methane (DCBM) were detected in all indoor air samples, while they were present in 98.3% and 82.6% of alveolar air samples respectively. Swimming pools have been splitted according to the suggested Italian guideline for combined chlorine in water ( 640.4 mg/l) assumed as the source of trichloramine, volatile irritative compound in indoor air. Subjects working in environments (15 swimming pools) where combined chlorine levels were above 0.4 mg/l experienced more symptoms of nasal obstruction and ocular irritative symptoms compared to those employed in swimming pools with lower levels in water

Disinfection by-products in drinking water: a comparison between chlorine and chlorine dioxide

To evaluate Disinfection By Products (DBPs) and relative amounts in drinking water following chlorine and/or chlorine dioxide treatments in comparison. In July 2005 to February 2006 12 waterworks (managed by Agenzia d'Ambito per i Servizi Pubblici di Modena-ATO) in Northern Italy were sampled twice, in summer and winter. In each sampling session 4 samples were collected: just before and immediately after the treatment, at the tap close to the disinfection plant and far from the plant. Main DBPs (trihalomethanes, chlorite, chlorate, bromate, and haloacetic acids) were investigated by headspace gas chromatography and ionic chromatography/mass spectrometry techniques.Nine water networks were supplied by ground water and 3 by mixed spring and surface water: chlorine was used for disinfection in 4 water systems and chlorine dioxide in 8. Bromate and haloacetic acids were never evidenced, whereas trihalomethanes showed very low values, increasing according to the distance from the disinfection plant and higher in summer. In chlorine dioxide-treated samples THMs ranged from <0.01 to 1 μg/L, whereas in chlorine-treated they ranged from 0.3 to 25 μg/L. Brominated THMs were measured at detectable levels in chlorine-treated samples only (range: 0.1-1 μg/L). Chlorite was evidenced in chlorine dioxide-treated samples only (range: 21-290 μg/L). Chlorate was measured in samples collected from all water networks (range: 2-276 μg/L).Neither chlorine nor chlorine dioxide form THMs at high levels in our samples; this is due to source water, which contains very low levels of organic substance even in case of surface water. Chlorite, produced by chlorine dioxide only, deserves attention as little information is available on its chemical reactions and fate in drinking water within water systems. More important to be investigated is the presence of chlorate, unexpectedly present in several water samples whatever disinfection treatment is used

NITROGEN TRICHLORIDE (NCl3) DETERMINATION IN INDOOR SWIMMING POOLS: PROPOSAL FOR A NEW METHOD.

It is well known that water disinfection treatments in indoor swimming pools generate a mixture of potentially harmful disinfection by-products (DBPs). Among them, nitrogen trichloride (NCl3), a powerful irritant, has been linked with respiratory symptoms and asthma in swimmers, mainly in children, and in occupationally exposed subjects. Accurate NCl3 exposure assessment in indoor swimming pools is difficult, because NCl3 presence in air is influenced by different factors, including the pool water quality and the number of swimmers in the pool. Moreover, the analytical method usually adopted for the determination of NCl3 in air samples shows some problems such as the use of particular filters for the air sampling procedures and the expansive instrumental equipments for the laboratory quantification of this volatile DBPs. The aim of this study was to identify a new analytical method for NCl3 air determination that could be used directly in swimming pool facilities for the human exposure assessment procedures. This new protocol is based on a colorimetric reaction commonly employed to detect the total and free chlorine levels in water. Particularly, it allows the entrapment of NCl3 in air into a water solution containing diethyl-p-phenylenediamine (DPD 1) and Potassium Iodide (DPD 3). Therefore, NCl3 from the air environment reacts with DPD 3 realising iodine, which reacts with DPD 1 and produces a pink colour. The intensity of the colour is proportional to the amount of NCl3 from the sampled indoor swimming pool air, and can be easily measured using a portable photometer for DPD analyses.The proposed method has been validated in terms of linearity, limit of detection (LOD) and repeatability. We tested the linearity by creating an artificial swimming pool environments under a closed chemical safety cabinet, and reading solutions of NCl3 in air sampling deriving from standards in water at different concentrations (5, 10, 20 mg/l of NCl3 standards). The actual concentration of NCl3 in the water was verified by adopting the same DPD method used in the real swimming pools. This linearity test was repeated three times and showed R2 values of: 0.996; 0.998 and 0.996. The LOD was measured either as standard deviation, which according to the instrument sensitivity and liters of air sampled, has values of 3.6 and 8.5 mg/l respectively. The repeatability showed a coefficient of variation (CV%) equal to 1.7%. The proposed method which is patent pending, is a method that does not use toxic substances, is easy to use, efficient and economical and gives good results in terms of linearity and repeatability

Sottoprodotti della clorazione ed altri composti alogenati nelle acque potabili della Provincia di Modena

Obiettivo di questa indagine è stato quello di identificare nelle acque potabili della Provincia di Modena i principali sottoprodotti della clorazione quali trialometani (THMs), clorito, clorato, bromato e acidi aloacetici (HAAs) ed altri composti indicatori di inquinamento urbano e industriale. Nel periodo luglio 2005 – febbraio 2006 sono stati effettuati prelievi in 12 reti idriche della Provincia di Modena. Ogni acquedotto è stato campionato in due diverse stagioni; per ogni campionamento sono stati raccolti 4 campioni di acqua (prima della disinfezione, subito dopo il trattamento, in rete a breve distanza dall’impianto e sempre in rete lontano dall’impianto).Gli HAAs e il bromato sono risultati sempre assenti in tutte le reti indagate, mentre i THMs sono risultati dosabili nel 35% dei campioni e sono risultati sempre inferiori al limite di 30 µg/l previsto dall’attuale normativa italiana (valore massimo osservato: 25,5 µg/l). Cloriti e clorati sono risultati dosabili rispettivamente nel 48% e nel 89% dei campioni con valori più elevati nei mesi invernali. In alcuni casi il clorito è risultato superiore ai 200 mg/l, limite che entrerà in vigore nel 2007, ma mai superiore ai 800 mg/l, limite attualmente in vigore.Lo ione clorato è risultato presente (max: 276 µg/l in un acquedotto) in quasi tutti i campioni di acqua, indipendentemente dal tipo di disinfettante utilizzato. Relativamente agli altri composti indagati, in quattro reti idriche è stata evidenziata la presenza in tracce di trielina, percloroetilene, metilcloroformio e tetracloruro di carbonio.Dai risultati ottenuti si può affermare che le acque potabili della Provincia di Modena sono di buona qualità, sia per quanto riguarda le acque di alimentazione che le acque distribuite in rete, e che la concentrazione dei vari composti indagati non devono destare preoccupazioni per quanto riguarda la salute della collettività

Natural killer activity in workers exposed to various levels of Extremely Low Frequency-Electromagnetic Fields (ELF-EMF)

Data on the effects of Extremely Low Frequency (ELF) Magnetic Fields (MF) on immune system in humans are conflicting. The aim of this study was to evaluate the NK cytotoxic activity in peripheral lymphocytes of a group of workers exposed to different levels of ELF-MF