{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:59:03Z","timestamp":1791208743173,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2010,3,29]],"date-time":"2010-03-29T00:00:00Z","timestamp":1269820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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 \u00b1 20.2 \u00b5g\/m3), while subjects working in cafe areas (17.6 \u00b1 12.1 \u00b5g\/m3), offices (14.4 \u00b1 12.0 \u00b5g\/m3) and engine rooms (13.6 \u00b1 4.4 \u00b5g\/m3) showed lower exposure levels. Employees with THM alveolar air values higher than 21 \u00b5g\/m3 (median value) experienced higher risks for red eyes (OR 6.2; 95% CI 2.6\u201314.9), itchy eyes (OR 3.5; 95% CI 1.5\u20138.0), dyspnea\/asthma (OR 5.1; 95% CI 1.0\u201327.2) and blocked nose (OR 2.2; 95% CI 1.0\u20134.7) 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.<\/jats:p>","DOI":"10.3390\/ijerph7041379","type":"journal-article","created":{"date-parts":[[2010,3,29]],"date-time":"2010-03-29T11:15:16Z","timestamp":1269861316000},"page":"1379-1391","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Prevalence of Ocular, Respiratory and Cutaneous Symptoms in Indoor Swimming Pool Workers and Exposure to Disinfection By-Products (DBPs)"],"prefix":"10.3390","volume":"7","author":[{"given":"Guglielmina","family":"Fantuzzi","sequence":"first","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Public Health Sciences, Via G. Campi, 287, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Righi","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Public Health Sciences, Via G. Campi, 287, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guerrino","family":"Predieri","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Public Health Sciences, Via G. Campi, 287, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Giacobazzi","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Public Health Sciences, Via G. Campi, 287, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katia","family":"Mastroianni","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Public Health Sciences, Via G. Campi, 287, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Aggazzotti","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Public Health Sciences, Via G. Campi, 287, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2010,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1136\/oem.55.4.258","article-title":"Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools","volume":"5","author":"Massin","year":"1998","journal-title":"Occup. Environ. Med"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1183\/09031936.02.00232802","article-title":"Occupational asthma caused by chloramines in indoor swimming-pool air","volume":"19","author":"Thickett","year":"2002","journal-title":"Eur. Respir. J"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1183\/09031936.02.00308602","article-title":"Indoor swimming pools, water chlorination and respiratory health","volume":"19","author":"Nemery","year":"2002","journal-title":"Eur. Respir. J"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00420-006-0100-0","article-title":"The determinants of prevalence of health complaints among young competitive swimmers","volume":"80","author":"Levesque","year":"2006","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1183\/09031936.00024706","article-title":"Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers","volume":"29","author":"Jacobs","year":"2007","journal-title":"Eur. Respir. J"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1289\/ehp.11513","article-title":"Childhood asthma and environmental exposures at swimming pools: State of the science and research recommendations","volume":"117","author":"Weisel","year":"2009","journal-title":"Environ. Health. Perspect"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1111\/j.0105-1873.2005.00699.x","article-title":"Self-reported skin disease in hydrotherapists working in swimming pools","volume":"53","author":"Lazarov","year":"2005","journal-title":"Contact Dermatitis"},{"key":"ref_8","unstructured":"WHO (World Health Organization) (2006). Guidelines for Safe Recreational-Water Environments, Vol. 2: Swimming Pools, Spas and Similar Recreational-Water Environments, World Health Organization."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/0003-4878(95)00013-5","article-title":"Exposure to chloramines in the atmosphere of indoor swimming pools","volume":"39","author":"Hery","year":"1995","journal-title":"Ann. Occup. Hygiene"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.puhe.2007.06.011","article-title":"Health effects associated with indoor swimming pools: a suspected toxic chloramines exposure","volume":"122","author":"Beach","year":"2008","journal-title":"Public Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6732","DOI":"10.1021\/es070871+","article-title":"Volatile disinfection by-product formation resulting from chlorination of organic-nitrogen precursors in swimming pools","volume":"41","author":"Li","year":"2007","journal-title":"Environ. Sci. Technol"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/0021-9673(95)00432-M","article-title":"Environmental and biological monitoring of chloroform in indoor swimming pools","volume":"710","author":"Aggazzotti","year":"1995","journal-title":"J. Chromatogr. A"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/S0048-9697(00)00722-1","article-title":"Occupational exposure to trihalomethanes in indoor swimming pools","volume":"264","author":"Fantuzzi","year":"2001","journal-title":"Sci. Total Environ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1136\/oem.59.4.243","article-title":"Distribution and determinants of trihalomethanes concentrations in indoor swimming pools","volume":"59","author":"Chu","year":"2002","journal-title":"Occup. Environ. Med"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1078\/1438-4639-00329","article-title":"Pathways of trihalomethanes uptake in indoor swimming pools","volume":"207","author":"Erdinger","year":"2004","journal-title":"Int. J. Hyg. Environ. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/S0048-9697(98)00174-0","article-title":"Blood and breath analyses as biological indicators of exposure to trihalomethanes in indoor swimming pools","volume":"217","author":"Aggazzotti","year":"1998","journal-title":"Sci. Total Environ"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1038\/sj.jea.7500139","article-title":"Uptake of chlorination disinfection by-products; a review and a discussion of its implications for exposure assessment in epidemiological studies","volume":"10","author":"Nieuwenhuijsen","year":"2000","journal-title":"J. Expo. Anal. Environ. Epidemiol"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1289\/ehp.7141","article-title":"Influence of tap water quality and household water use activities on indoor air and internal dose levels of trihalomethanes","volume":"113","author":"Nuckols","year":"2005","journal-title":"Environ Health Perspect"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5002","DOI":"10.1021\/es800415p","article-title":"Alveolar air and urine analyses as biomarkers of exposure to trihalomethanes in an indoor swimming pool","volume":"42","author":"Caro","year":"2008","journal-title":"Environ. Sci. Technol"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1016\/j.scitotenv.2008.11.021","article-title":"Characteristics of trihalomethane (THM) production and associated health risk assessment in swimming pool waters treated with different disinfection methods","volume":"407","author":"Lee","year":"2009","journal-title":"Sci. Total Environ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1289\/ehp.97105636","article-title":"Alveolar breath sampling and analysis to assess trihalomethane exposures during competitive swimming training","volume":"105","author":"Lindstrom","year":"1997","journal-title":"Environ. Health Persp"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1002\/j.1551-8833.1957.tb16870.x","article-title":"The determination of free and combined chlorine in water by the use of diethyl-p-phenylene diamine","volume":"49","author":"Palin","year":"1957","journal-title":"J. Am. Water. Works Assoc"},{"key":"ref_23","unstructured":"(1986). SPSS (Statistical Package for Social Sciences) version 160 (SPSS\/PC), SPSS Inc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/ajim.20423","article-title":"The effects of physical and chimical properties of swimming pool water and its close environment on the development of contact dermatitis in hydrotherapists","volume":"50","author":"Pardo","year":"2007","journal-title":"Am. J. Ind. Med"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.chemosphere.2009.07.056","article-title":"Henry\u2019s law constant of N,N-dichloromethylamine: application to the contamination of the atmosphere of indoor swimming pools","volume":"77","author":"Cimitiere","year":"2009","journal-title":"Chemosphere"},{"key":"ref_26","unstructured":"Centers for Disease Control and Prevention (CDC) (2009). Respiratory and ocular symptoms among employees of a hotel indoor water park resort\u2014Ohio, 2007. MMWR Morb. Mortal. Wkly. Rep, 58, 81\u201385."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1080\/13547500210166612","article-title":"Changes of serum pneumoproteins caused by short term exposures to nitrogen trichloride in indoor chlorinated pools","volume":"7","author":"Carbonelle","year":"2002","journal-title":"Biomarkers"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1136\/oem.60.6.385","article-title":"Lung hyperpermeability and asthma prevalence in schoolchildren: unexpected associations with the attendance of indoor chlorinated pools","volume":"60","author":"Bernard","year":"2003","journal-title":"Occup. Environ. Med"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1542\/peds.2006-3333","article-title":"Infant swimming practice, pulmonary epithelium integrity, and the risk of allergic and respiratory diseases later in childhood","volume":"6","author":"Bernard","year":"2007","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1183\/09031936.00180608","article-title":"Swimming pool attendance and risk of ashma and allergic symptoms in children","volume":"34","author":"Kogevinas","year":"2009","journal-title":"Eur. Respir. J"},{"key":"ref_31","first-page":"31","article-title":"Swimming pool, respiratory health and childhood asthma: should we change our beliefs?","volume":"44","author":"Uyian","year":"2009","journal-title":"Pediatric Pneumology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1080\/02770900802165980","article-title":"Asthma and swimming: a meta-analysis","volume":"45","author":"Goodman","year":"2008","journal-title":"J. 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