Swimming pools and health-related behaviours: results of an Italian multicentre study on showering habits among pool users

Objectives

Showering before entering a swimming pool is highly recommended to reduce the risk of biological and chemical contamination. This study evaluated the behaviour of indoor swimming pool users; analysed the variables associated with lack of showering; and assessed awareness of the importance of showering.

Study design

Cross-sectional study.

Methods

A self-administered questionnaire was used to collect data about users of swimming pools located in five different Italian cities. The association between specific variables and the lack of showering was assessed. P < 0.05 was considered to indicate statistical significance.

Results

In total, 4356 questionnaires were analysed. Sixty-five percent of interviewees always showered before entering the pool. The main reason given for pre-swim showering was ‘to wash oneself’ (50.5%); or ‘to get used to the temperature of the water’ (44.3%); and 5.2% answered ‘for both reasons’. Risk factors significantly associated with lack of showering were: female sex (odds ratio (OR) 1.37, 95% confidence interval (CI) 1.2–1.59), age 14–17 years (OR 5.09, 95% CI 3.40–7.64); not reading the swimming pool rules (OR 1.24, 95% CI 1.10–1.41); living in Central Italy (OR 3.3, 95% CI 2.65–4.1) or Southern Italy (OR 1.35, 95% CI 1.18–1.55); and previous/current attendance of a swimming course (OR 1.7, 95% CI 1.48–1.97).

Conclusions

The results revealed low compliance with the rule of showering before entering a swimming pool, and little awareness of the preventive role of showering in the hygienic management of swimming pools. There is a need for targeted educational interventions to inform swimming pool users of the reasons for the importance of showering before entering a pool.     

Risk factors for single and recurrent falls: A prospective study of falls in community dwelling seniors without cognitive impairment

Objective

The purpose of this study is to contribute evidence towards heterogeneity in risk factors for single and recurrent falls.

Method

This is a prospective study conducted in Taiwan. Participants were randomly selected from the examinees of the annual health examination in 2010. Participants were interviewed with a detailed questionnaire and followed up one year later. Predictor variables included socio-demographic characteristics, medical conditions, laboratory data, and risk factors for osteoporosis. The outcome was falls in the ensuing 12 months.

Results

The mean age of the 653 completers was 75.6 ± 6.4. Half (48.7%) were women. Fallers and recurrent fallers comprised 14.5% and 6.0% of the participants, respectively. Blurred vision (adjusted odds ratio (aOR): 1.93, 95% confidence interval (CI): 1.02–3.67), minimal outdoor activities (aOR: 2.28, 95% CI: 1.06–4.88), and overactive thyroid/parathyroid (aOR: 3.49, 95% CI: 1.29–9.50) were associated with single falls. Frailty (aOR: 2.81, 95% CI: 1.11–7.09), decreased body height (aOR: 3.15, 95% CI: 1.52–6.54) and taking sedatives/hypnotics (aOR: 4.23, 95% CI: 2.06–8.67) were associated with recurrent falls. Previous falls (aOR: 2.64, 95% CI: 1.44–4.84 for single falls; aOR: 5.26, 95% CI: 2.61–10.60 for recurrent falls) were associated with all falls.

Conclusion

Different intervention strategies should be developed for single and recurrent fallers.     

Socio-demographic and behavioral determinants of hepatitis B vaccination and infection in pregnant women on Mayotte Island,Indian Ocean

Background

Socio-demographic and behavioral determinants of Hepatitis B virus (HBV) vaccination and infection among pregnant women (PW) of Mayotte Island (Indian Ocean) are not well understood.

Methods

Six hundred and seventy-one pregnant women presenting to public antenatal clinics on Mayotte Island were included between September 15, 2008 and September 27, 2009. Socio-demographics, sexual risk behavior characteristics, and data for HBV biomarkers were collected. Logistic regression was undertaken to study determinants of HBV vaccination and factors associated with the risk of HBV infection were assessed using a survival method adapted to interval-censored data. Due to missing data for HBV biomarkers, data were analyzed using multiple imputation (MI).

Results

Past or recent HBV infection was observed for 35.5% (95% confidence interval (CI): 30.4–40.8) of PW and 18.6% (95% CI: 14.7–23.2) had evidence of HBV vaccination. PW with unemployed and education qualification (adjusted odds ratio (aOR) 2.65, 95% CI 1.52–4.60) and student status (aOR 4.79, 95% CI 1.63–4.07) were better vaccinated against HBV, compared to those without employment and education. Being born on Comoros was associated with a 63% reduction in HBV vaccination (aOR 0.37, 95% CI 0.21–0.65), compared to be born in Mayotte/France. Women with a history of sexually-transmitted infections in the last 5 years had an increased risk of HBV infection (adjusted hazard ratio (aHR) 3.10, 95% CI: 1.13–8.50), whereas those who sometimes used condoms had a 60% reduced risk (aHR = 0.40, 95% CI: 0.23–0.69).

Conclusions

Socio-demographic factors were identified for HBV vaccination, while behavioral factors were observed for HBV infection. These results could help to determine priorities for intervention.     

Association between state physical education (PE) requirements and PE participation,physical activity,and body mass index change

Objective

To determine if state physical education (PE) laws are associated with student physical education attendance and physical activity (PA), and whether physical education and competitive food laws, in conjunction, are associated with lower BMI change.

Method

State laws regarding physical education time requirements and competitive foods in 2003 and 2006 were classified as strong, weak, or none, based on codified law ratings obtained from the Classification of Laws Associated with School Students. Laws were linked to student data on PE attendance and physical activity (8th grade, Spring 2007) and BMI change (5th–8th grade, 2004–2007), obtained from the Early Childhood Longitudinal Study (n = 5510 students in 40 states).

Results

Girls reported 0.31 more days of activity (95% CI: 0.02, 0.61) and were more likely to attend physical education ≥ 3 days/week (74.1% versus 52.1%, difference = 22.0, 95% CI: 2.1, 42.0) if they resided in states with strong physical education laws compared to no physical education laws. Weak physical education laws had modest associations with PE and activity, and there was no evidence that weak laws reduce BMI gain regardless of competitive food laws.

Conclusion

Strong physical education laws with specific time requirements may increase physical education attendance and activity in girls. There is insufficient evidence that physical education laws reduce student weight gain.     

Association between documented family history of cancer and screening for breast and colorectal cancer

Background

Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings.

Purpose

To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening.

Methods

Medical record reviews were conducted on 3433 patients aged 55 and older from four primary care practices in two rural Oregon communities. Data collected included patient demographic and risk information, including any documentation of family history of breast or colorectal cancer, and receipt of screening for these cancers.

Results

A positive breast cancer family history was associated with an increased likelihood of being up-to-date for mammography screening (OR 2.09, 95% CI 1.45–3.00 relative to a recorded negative history). A positive family history for colorectal cancer was associated with an increased likelihood of being up-to-date with colorectal cancer screening according to U.S. Preventive Services Task Force low risk guidelines for males (OR 2.89, 95% CI 1.15–7.29) and females (OR 2.47, 95% CI 1.32–4.64) relative to a recorded negative family history. The absence of any recorded family cancer history was associated with a decreased likelihood of being up-to-date for mammography screening (OR 0.70, 95% CI 0.56–0.88 relative to recorded negative history) or for colorectal cancer screening (OR 0.75, 95% CI 0.60–0.96 in females, OR 0.68, 95% CI 0.53–0.88 in males relative to recorded negative history).

Conclusion

Further research is needed to determine if establishing routines to document family history of cancer would improve appropriate use of cancer screening.     

Cigarette smoking in Chinese adolescents: importance of controlling the amount of pocket money

Objective

To estimate the proportion of smokers that could potentially have been prevented from smoking by limiting the amount of pocket money received by Chinese adolescents.

Study design

Cross-sectional study.

Methods

Current smoking, ever smoking and the amount of pocket money were determined through self-administered questionnaires among 12,708 adolescents (aged 12–18 years) from 21 schools in Shanghai, China.

Results

Adjusted odds ratios for current smoking ranged from 2.0 [95% confidence interval (CI) 1.5–2.7] for adolescents receiving 200–399 Reminbin (RMB)/month as pocket money to 6.5 (95% CI 3.3–12.7) for those receiving ≥1000 RMB/month, compared with those receiving <200 RMB/month. The crude population-attributable risk percentage (PAR%) due to higher pocket money (≥200 RMB/month) for current smoking was 50.4% (95% CI 42.2–57.4), and adjusted PAR% was 43.3% (95% CI 30.7–53.1).

Conclusions

Approximately half of current smokers may have been prevented from smoking if pocket money was limited to <200 RMB/month among Chinese adolescents. An even larger proportion could have been prevented from smoking if pocket money was reduced further. It is recommended that future intervention programmes should target parents to reduce the amount of pocket money in China.     

Relationship between peri-operative outcomes and hospital surgical volume of total hip arthroplasty in Japan

Background

This study aimed to evaluate the relationship between peri-operative complication of total hip arthroplasty (THA) and hospital surgical volume.

Methods

We reviewed discharge administrative data from 8321 patients who underwent primary THA between July and December 2008. Relationships between complications and surgical volume were analyzed with multivariate logistic regression models including age, sex, and Charlson comorbidity index. Hospitals were categorized into four groups according to the 6-month volume of THA procedures.

Results

The most frequent complication was dislocation (1.41%). Next was infection (1.24%). Fracture and pulmonary embolism occurred in less than 1% of procedures. Patients who underwent THA in hospitals with the highest surgical volume had lower risk of dislocation and infection than those treated in the hospitals with the lowest surgical volume (odds ratio [OR] 0.321, 95% confidence interval [CI] 0.167–0.572 and OR 0.123, 95% CI 0.020–0.421). Patients aged 65 years and older were associated with increased risk of dislocation (OR 2.342, CI 1.555–3.624) and fracture (OR 2.799, CI 1.372–6.301). Females demonstrated lower risk of dislocation (OR 0.558, CI 0.352–0.869) and infection (OR 0.560, CI 0.365–0.882).

Conclusion

These results indicated that the increase in the risk of peri-operative dislocation of primary THA may be associated with low hospital surgical volume as well as age and male sex.     

Childhood Asthma and Environmental Exposures at Swimming Pools: State of the Science and Research Recommendations

Objectives

Recent studies have explored the potential for swimming pool disinfection by-products (DBPs), which are respiratory irritants, to cause asthma in young children. Here we describe the state of the science on methods for understanding children’s exposure to DBPs and biologics at swimming pools and associations with new-onset childhood asthma and recommend a research agenda to improve our understanding of this issue.

Data sources

A workshop was held in Leuven, Belgium, 21–23 August 2007, to evaluate the literature and to develop a research agenda to better understand children’s exposures in the swimming pool environment and their potential associations with new-onset asthma. Participants, including clinicians, epidemiologists, exposure scientists, pool operations experts, and chemists, reviewed the literature, prepared background summaries, and held extensive discussions on the relevant published studies, knowledge of asthma characterization and exposures at swimming pools, and epidemiologic study designs.

Synthesis

Childhood swimming and new-onset childhood asthma have clear implications for public health. If attendance at indoor pools increases risk of childhood asthma, then concerns are warranted and action is necessary. If there is no such relationship, these concerns could unnecessarily deter children from indoor swimming and/or compromise water disinfection.

Conclusions

Current evidence of an association between childhood swimming and new-onset asthma is suggestive but not conclusive. Important data gaps need to be filled, particularly in exposure assessment and characterization of asthma in the very young. Participants recommended that additional evaluations using a multidisciplinary approach are needed to determine whether a clear association exists.     

Risk of Dementia Among Patients With Asthma: A Nationwide Longitudinal Study

Background

Previous studies have suggested an association between asthma and dementia, but the results are still inconsistent.

Methods

Using the Taiwan National Health Insurance Database, we enrolled 11,030 participants aged more than 45 years with asthma and 44,120 (1:4) age-/sex-matched controls between 1998 and 2008, and followed them to the end of 2011. Cases of any dementia or Alzheimer's disease that developed during the follow-up period were identified.

Results

Asthma was associated with an increased risk of developing any dementia [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.87–2.52] and Alzheimer's disease (HR: 2.62, 95% CI: 1.71–4.02). Stratified by age, both asthma in midlife (>45 years and <65 years) and in late life (≥65 years) was associated with a greater likelihood of any dementia (HR: 2.48, 95% CI: 1.80–3.41; HR: 2.06, 95% CI: 1.74–2.44).

Discussion

Asthma in midlife and in late life increased the risk of developing any dementia and Alzheimer's disease. The underlying mechanisms between asthma and dementia require further investigation.     

Life-style and self-rated global health in Sweden: A prospective analysis spanning three decades

Objective

To study the relations between lifestyle factors (smoking, drinking, exercise, vegetable consumption, social relations) and global self-rated health in the adult Swedish population.

Method

The data come from the Swedish Level of Living Survey, a face-to-face panel study. The analysis follows the respondents with good health in 1991 (N = 4035) and uses multivariate logistic regression to assess the relations between lifestyle factors in 1991 and health in 2000 and 2010.

Results

Baseline (1991) exercise, social support, smoking and vegetable consumption are associated with health in 2000 and/or 2010. 2000: Weekly exercise in 1991 increases the probability of good health by 6 percentage points [95% CI: 1–10] compared to no exercise, and smoking 10 or more cigarettes a day decreases the probability of good health by 5 percentage points [95% CI 1–8]. Lacking social support decreases the probability of good health by 17 percentage points (95% CI: 9–25). 2010: Smoking 10 or more cigarettes a day decreases the probability of good health by 10 percentage points [95% CI 5–15], and eating vegetables every day increases the probability of good health by 4 percentage points [95% CI 0.2–7].

Conclusions

Exercise, smoking, social support and vegetable consumption are related to self-rated health 2000 and/or 2010.     

Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test

Objective

The objective was to determine if simplified follow-up after early medical abortion, consisting of a telephone call 2 weeks after the procedure plus a self-performed low-sensitivity urine pregnancy (LSUP) test, was successful for screening for ongoing pregnancies in the year following its introduction as standard service.

Study design

A retrospective computerized database review of 1084 women at a hospital abortion service in Edinburgh, UK, who had a medical abortion (≤ 9 weeks) and went home to expel the pregnancy was performed. Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result were scheduled for an ultrasound. The main outcome measures were the proportion of women scheduled for telephone follow-up successfully contacted and the proportion of ongoing pregnancies detected.

Results

A total of 943 women were scheduled for telephone follow-up. Ten women presented to the hospital before the time of the follow-up call. Of the remaining 933 women, 656 [70%, 95% confidence interval (CI) 67.7-73.2] were successfully contacted. Five hundred seventy-three (87%, 95% CI 84.5–89.7) of those contacted screened ‘negative’; no false negatives occurred. Eighty-three (13%, 95% CI 10.2–15.5) screened ‘positive,’ and of those, three had ongoing pregnancies. Of the 277 (30%, 95% CI 26.7–32.7) who were not contacted, two ongoing pregnancies occurred. The sensitivity of telephone follow-up with LSUP to detect ongoing pregnancy was 100% (95% CI 30.9%–100%), and specificity was 88% (95% CI 84.9%–90.1%). The negative predictive value was 100% (95% CI 99.1%–100%), and positive predictive value was 3.6% (95% CI 0.9%–10.9%).

Conclusion

A telephone call and LSUP test at 2 weeks are suitable as a standard method of follow-up for screening for ongoing pregnancy after early medical abortion.

Implications statement

For most women, a routine clinic follow-up after early medical abortion (to exclude ongoing pregnancy) can be replaced with a telephone call and a self-performed LSUP test at 2 weeks postprocedure.     

Risk Analysis for Second Hip Fracture in Patients After Hip Fracture Surgery: A Nationwide Population-Based Study

Objectives

The current treatment program for fragility hip fractures (HFx) emphasizes a combination of early surgery, rehabilitation, and tertiary prevention strategy for osteoporosis; however, the effect is unclear and little information is available on the risk factors predicting the occurrence of a second hip fracture (SHFx). The aim of this study was to explore the incidence, risk factors, and subsequent mortality of SHFx in patients after their first hip fracture surgery (HFxS).

Design, Setting, and Participants

We performed a nationwide population-based longitudinal observational study using the National Health Insurance Research Database (NHIRD) of Taiwan with a logistic regression model analysis. Of 87,415 patients undergoing HFxS during the period 2004 to 2007, we identified 8027 patients who had sustained an SHFx for analyses.

Measurements

Data collected included patient characteristics (demographics, comorbidities, and concurrent medication use), incidence and hazard ratios of SHFx after HFxS, and subsequent age-specific mortality.

Results

The overall incidence of SHFx was 9.18% and the age-specific mortality was increased 1.6- to 2.2-fold in patients with SHFx compared with those without after HFxS in this 7-year longitudinal study. The identified risk factors included age (AOR = 1.84, 95% CI: 1.24–2.89), female gender (AOR = 1.12, 95% CI: 1.03–2.30), obesity (AOR = 2.89, 95% CI: 1.81–3.01), diabetes (AOR = 3.85, 95% CI: 2.54–4.05), arterial hypertension (AOR = 2.45, 95% CI: 1.83–2.62), hyperlipidemia (AOR = 2.77, 95% CI: 1.27–3.19), stroke/TIA (AOR = 2.85, 95% CI: 2.20–3.23), blindness/low vision (AOR = 3.09, 95% CI: 2.54–3.73), and prolonged use of analgesics and anti-inflammatory medications (all AOR ≥ 3.05, all P values ≤.012). Bisphosphonate therapy after HFxS had a significant negative risk association with the development of an SHFx (20.8% vs 32.3%, P = .023; AOR = 2.24, 95% CI: 1.38–2.90).

Conclusion

We concluded that the occurrence of an SHFx and subsequent mortality in patients after HFxS is rather high. An understanding of the risk factors predicting the occurrence of an SHFx provides a valuable basis to improve health care for geriatric populations.     

Safety of inactivated monovalent pandemic (H1N1) 2009 vaccination during pregnancy: A population-based study in Taiwan

Background

Pregnant women were prioritized for H1N1 vaccination during the 2009–2010 pandemic. Safety concerns exist with vaccinating pregnant women, particularly in their first trimesters.

Methods

We linked computerized data on H1N1 vaccination, National Health Insurance, and Taiwan Birth Registry and identified events of spontaneous abortions (SABs) and all singleton births that occurred/delivered during November 1, 2009–September 30, 2010. The observation period for each case of SAB (6–19 weeks gestation) was divided into period at risk (1–28 days after vaccination) and control periods (the remaining person-days until SAB). The self-controlled case series method for truncated observational periods assessed the incidence rate ratio (IRR) of SAB during the 1–28 days compared with those in the control period. The case-control design matched each case of adverse fetal outcomes to up to 10 controls on fetal sex and year/month of pregnancy onset, and calculated matched odds ratio (OR) on H1N1 vaccination at <14 or ≥14 weeks gestation.

Results

Sixty-five women with SAB had received H1N1 vaccination at 6–19 weeks gestation. The IRR of SAB for the risk period 1–28 days was 1.03 (95% confidence interval [CI] 0.55–1.93). Among the 147,294 live births and 1354 stillbirths, maternal H1N1 vaccine receipt at <14 weeks gestation was associated with significantly reduced likelihood of small for gestational age (SGA) birth (OR 0.72, 95% CI 0.61–0.84) and birth defect (OR 0.46, 95% CI 0.22–1.00), whereas receipt at ≥14 weeks gestation was associated with significantly reduced likelihood of stillbirth (OR 0.63, 95% CI 0.46–0.86), prematurity (OR 0.90, 95% CI 0.83–0.97), low birth weight (OR 0.81, 95% CI 0.74–0.88), and SGA birth (OR 0.90, 95% CI 0.84–0.97).

Conclusions

H1N1 vaccination during pregnancy did not increase risk of SAB or adverse fetal outcomes.     

Muscle strength and physical activity are associated with self-rated health in an adult Danish population

Objective

To describe associations of muscle strength, physical activity and self-rated health.

Method

Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30 s repeated chair stand test (30 s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007–2008.

Results

Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR = 6.84, 95% CI: 4.85–9.65 and OR = 7.34, 95% CI: 5.42–9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30 s-CS test (6.06, 95% CI: 4.32–8.50 and 13.38, 95% CI: 9.59–18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30 s-CS).

Conclusion

The combined score for physical activity level with either HGS or 30 s-CS was strongly positively associated with self-related health.     

Nonmedical exemptions to immunization requirements in California: A 16-year longitudinal analysis of trends and associated community factors

Background

Rates of nonmedical exemptions to kindergarten-entry immunization requirements have increased over the past 2 decades, especially in states that permit philosophical exemptions and/or have easier administrative policies for obtaining nonmedical exemptions. We evaluated trends in school personal belief exemption rates over the period 1994–2009 in California, and associated school and community characteristics.

Methods

We used data on personal belief exemptions from 6392 public and private elementary schools from the California Department of Public Health, as well as census tract and school demographic data. Generalized estimating equations were used to model annual mean increases in personal belief exemption rates, and to identify school and community characteristics associated with personal belief exemption rates.

Results

Over the study period, the average school personal belief exemption rate increased from 0.6% in 1994 to 2.3% in 2009, an average of 9.2% (95% CI: 8.8–9.6%) per year. The average personal belief exemption rate among private schools over the entire study period was 1.77 (95% CI: 1.55–2.01) times that among public schools. The annual rate of increase was slightly higher among private schools (10.1%, 95% CI: 9.1–11.1%) than among public schools (8.8%, 95% CI: 8.4–9.2%). Schools located within census tracts classified as rural had 1.66 (95% CI: 1.26–2.08) times higher personal belief exemption rates than schools located within urban census tracts. Exemption rates were also associated with race, population density, education, and income.

Conclusions

This study confirms concerns about increasing rates of nonmedical exemptions to kindergarten vaccine requirements within the state of California, using data collected over a 16-year period.     

Seasonal influenza vaccine effectiveness in pre- and full-term children aged 6–23 months over multiple seasons

Introduction

This study aimed to determine the effectiveness of seasonal influenza vaccine in pre- and full-term children aged 6–23 months.

Methods

We examined a cohort of 683,354 young children (7.7% preterm) over five influenza seasons (2004–2005 to 2008–2009) in Ontario, Canada. Vaccine effectiveness was estimated using influenza-coded ambulatory visits during virologically-confirmed influenza season periods as the outcome and multivariable Cox proportional hazards modeling.

Results

Full vaccination was associated with a 19% reduction in influenza-coded ambulatory visits (HR = 0.81; 95% CI, 0.68–0.97) in all children, and an 18% reduction in full-term children (HR = 0.82; 95% CI, 0.68–0.99). We did not find significant vaccine effectiveness for preterm children. No benefit was found for partial vaccination.

Conclusions

In children younger than two years, only full influenza vaccination is associated with reduced influenza-coded ambulatory visits. Since the effectiveness of influenza vaccination in preterm children remains uncertain, further study of this highly vulnerable population is warranted.     

Maternal outcomes of intimate partner violence during pregnancy: study in Iran

Objectives

To investigate the prevalence of intimate partner violence (IPV) against pregnant women and its relationship with adverse maternal outcomes, including preterm labour, abortion, caesarean section, antenatal hospitalization and vaginal bleeding, in the West Azerbaijan, Iran.

Study design

Cross-sectional design.

Methods

In total, 1300 pregnant women, aged 18–39 years, who were referred to hospitals in the Iranian cities of Miandoab and Mahabad in the province of West Azerbaijan in 2009–2010 were recruited for this study by a convenience sampling method. Participants were asked to share their experiences of IPV during pregnancy and adverse maternal outcomes.

Results

Of these pregnant women, 945 (72.8%) reported that they had experienced IPV during their last pregnancy. A significant association was found between IPV and preterm labour [adjusted odds ratio (adjOR) 1.54, 95% confidence interval (CI) 1.16–2.03], caesarean section (adjOR 11.84, 95% CI 6.37–22.02), antenatal hospitalization (adjOR 6.34, 95% CI 3.82–10.52) and vaginal bleeding (adjOR 1.51, 95% CI 0.9–2.3).

Discussion

This study demonstrated a high prevalence of IPV during pregnancy, and found that IPV was associated with adverse maternal outcomes including preterm labour, caesarean section, antenatal hospitalization and vaginal bleeding. This adds to the existing literature and can be used to inform healthcare practices in developing countries. Medical, health and surgical services for pregnant women should consider screening for IPV, and providers should be aware that IPV victims are at increased risk for adverse outcomes. Services should also develop links with the Battered Women's Movement; such programmes now exist in many countries.     

Concentración de cloro en el aire de las piscinas cubiertas y sus efectos en la salud de los trabajadores a pie de piscina

Objective

To describe chlorine levels in the air of indoor swimming pools in Castilla-La Mancha (Spain) and relate them to other chemical parameters in the installation and to the health problems perceived by swimming pool workers.

Methods

We analyzed 21 pools with chlorine as chemical treatment in Castilla-La Mancha. The iodometry method was applied to measure chlorine concentrations in the air. The concentrations of free and combined chlorine in water, pH and temperature were also evaluated. Health problems were surveyed in 230 swimming pool workers in these facilities.

Results

The mean chlorine level in the air of swimming pools was 4.3 ± 2.3 mg/m³. The pH values were within the legal limits. The temperature parameters did not comply with regulations in 17 of the 21 pools analyzed. In the pools where chlorine values in the air were above the legal regulations, a significantly higher percentage of swimming pool workers perceived eye irritation, dryness and irritation of skin, and ear problems.

Conclusions

Chlorine values in the air of indoor swimming pools were higher than those reported in similar studies. Most of the facilities (85%) exceeded the concentration of 1.5 mg/m³ established as the limit for the risk of irritating effects. The concentration of chlorine in indoor swimming pool air has a direct effect on the self-perceived health problems of swimming pool workers.