Occup Environ Med

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Occupational and Environmental Medicine 2007;64:6-7; doi:10.1136/oem.2006.029850
Copyright © 2007 by the BMJ Publishing Group Ltd.
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COMMENTARY

The chlorine hypothesis: fact or fiction?

M J Nieuwenhuijsen

Correspondence to:
Correspondence to:
Dr M J Nieuwenhuijsen
Department of Epidemiology & Public Health, Division of Primary Care & Population Health Sciences, Faculty of Medicine, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK;m.nieuwenhuijsen@imperial.ac.uk

Commentary on the paper by Nickmilder and Bernard (see page 37)

The first 150 words of the full text of this article appear below.

In this issue, Nickmilder and Bernard1 report on the relationship between the number of indoor chlorination swimming pools and prevalence of wheeze, asthma, hay fever, rhinitis and atopic eczema in European study centres of the International Study of Asthma and Allergies in Childhood (ISAAC) using an ecological study design with adjustment for several indicators such as social economic and lifestyle factors. They found statistically significant positive relationships for all outcomes for the whole of Europe, but fewer when examining specific regions of Europe. They found no statistically significant relationships within countries, but the number of study centres within a specific country was generally small. The relationship was stronger for 13–14-year-olds than for 6–7-year-olds.

Does this ecological study help to move the field forward? We are all aware of the strength and particularly the limitations of an ecological study design, and the interpretation of the results is generally far from straight . . . [Full text of this article]


Relevant Article

Ecological association between childhood asthma and availability of indoor chlorinated swimming pools in Europe
M Nickmilder and A Bernard
Occup. Environ. Med. 2007 64: 37-46. [Abstract] [Full Text] [PDF]





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