Airborne trichloramine (NCl(3)) levels and self-reported health symptoms in indoor swimming pool workers: dose-response relationships.

The hypothesis that attendance at indoor chlorinated swimming pool is a risk factor for irritative ocular and respiratory symptoms and bronchial asthma is well known in literature, although epidemiological evidence is still inconclusive. The aim of this study was to evaluate the association between airborne trichloramine (NCl(3)) levels and irritative symptoms in swimming pool employees in order to obtain detailed data regarding dose-response relationships and to identify the airborne NCl(3) exposure level, if any, without health effects. A total of 20 indoor swimming pools in the Emilia Romagna region of Italy were included in the study. Information about the health status of 128 employees was collected using a self-administered questionnaire. Exposure to airborne NCl(3) was evaluated in indoor swimming pools by a modified DPD/KI method. The results of the study evidenced a mean value of airborne NCl(3) of 0.65±0.20 mg/m(3) (ranging from 0.20 to 1.02 mg/m(3)). Both ocular and upper respiratory symptoms, in particular red eyes, runny nose, voice loss and cold symptoms, were declared more frequently by lifeguards and trainers when compared with employees working in other areas of the facility (office, cafe, and so on). Pool attendants exposed to airborne NCl(3) levels of >0.5 mg/m(3) experienced higher risks for runny nose (OR: 2.91; 95% CI: 1.22-6.93) red eyes (OR: 3.16; 95% CI: 1.46-6.82), voice loss (OR: 3.56; 95% CI: 1.60-7.95) and itchy eyes (OR: 2.23; 95% CI: 1.04-4.78) than other employees. Moreover, red eyes, itchy eyes, runny nose and voice loss are related to airborne NCl(3) levels, with strong dose-response relationships. In conclusion, this study shows that lifeguards and trainers experience ocular and respiratory irritative symptoms more frequently than employees not exposed. Irritative symptoms become significant starting from airborne NCl(3) levels of >0.5 mg/m(3), confirming that the WHO-recommended value can be considered protective in occupational exposure to airborne NCl(3) in indoor swimming pools.

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 microg/m(3)), while subjects working in cafe areas (17.6 +/- 12.1 microg/m(3)), offices (14.4 +/- 12.0 microg/m(3)) and engine rooms (13.6 +/- 4.4 microg/m(3)) showed lower exposure levels. Employees with THM alveolar air values higher than 21 microg/m(3) (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 years) 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.

Trace elements, anxiety and immune parameters in patients affected by cancer.

The aim of this case-control study was to investigate the relationship between trace elements, immune parameters, and human cancer, taking into account some personality traits, such as anxiety, implicated in the modulation of both immune responses and pathology. Thirty patients affected by the most frequent cancer types were recruited at the onset of disease together with 30 healthy controls. Se, Zn and Cu were measured in plasma together with glutathione peroxidase (GSH-Px) activity, and lipid peroxidation (thiobarbituric acid-reactive substances--TBARS). Furthermore, Zn and GSH-Px activity were measured in red blood cells. A complete blood profile with the main lymphocytes subsets was obtained and the State-Trait Anxiety Inventory was applied to evaluate anxiety. The only differences found between trace element levels in cases and controls were significantly higher erythrocyte Zn in cancer patients and higher plasma Cu levels in male patients. In addition, subjects affected by cancer exhibited a significant reduction in TBARS levels, were more anxious, had lower total B cells percentage and T helper/T suppressor ratio, and had a higher percentage of natural killer cells. Interestingly, in patients only, GSH-Px in plasma was positively related to trait anxiety scores (p < 0.02) and Cu to state anxiety scores (p < 0.05). In conclusion, we could not confirm the existence of trace element deficiency in relation to cancer and no links between trace element levels and lymphocyte subsets were documented. However, interesting associations between state anxiety and Cu, and between trait anxiety and GSH-Px were observed thus deserving further investigations.