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Abstract: In the three-year period 2010–2012, 80 public swimming facilities in the metropolitan area of Bologna (Emilia Romagna Region, Italy), including 144 pools (69 indoor, 75 outdoor), were monitored to assess the microbiological and chemical water quality, after about ten years of implementing the new Italian guidance which introduced the principles of internal safety plans in the surveillance of swimming pools. According to the Italian guidance, water samples were collected from supply water (370 samples), pool water (645), and recirculating water entering the pool (307). The samples of supply water always conformed to the microbiological limits for drinking water. The pool water did not conform to the Italian legal requirements in around 16% of indoor pools and 25% of outdoor pools. In 65% of non-compliant samples, only one parameter exceeded the required standards. The microorganisms of faecal origin were isolated very rarely (Enterococci in less than 2% of samples) and pH and residual chlorine showed good compliance in pool water, implying an efficient management of the internal control. The inlet water exceeded the required standards in about 36% and 50% of samples, respectively in indoor and outdoor pools. However, 83.6% of the corresponding samples of pool water met the required limits. The microbiological incongruities were prevalently due to high levels of total heterotrophic counts (THCs) and Pseudomonas aeruginosa, and were indicative of bacterial colonization of the filters. The sampling of inlet water can thus be indicated as a critical control point for checking the correct functioning of the filters. The non-conformity of samples led to pool closure only in 1.5% of cases. In the other cases, the operators were officially invited to perform the corrective measures previously established in the plan of risk assessment. On the whole, the approach based on internal safety plans produced satisfactory results in terms of pool water quality, demonstrating the effective working of the internal system of analysis and management of risks. [Copyright &y& Elsevier]

The study aimed to assess the efficacy of an integrated water safety plan (WSP) in controlling Legionella re-growth in a respiratory hydrotherapy system located in a spa centre, supplied with sulphurous water, which was initially colonized by Legionella pneumophila. Heterotrophic plate counts, Pseudomonas aeruginosa, Legionella spp. were detected in water samples taken 6-monthly from the hydrotherapy equipment (main circuit, entry to benches, final outlets). On the basis of the results obtained by the continuous monitoring and the changes in conditions, the original WSP, including physical treatments of water and waterlines, environmental surveillance and microbiological monitoring, was integrated introducing a UV/ultrafiltration system. The integrated treatment applied to the sulphurous water (microfiltration/UV irradiation/ultrafiltration), waterlines (superheated stream) and distal outlets (descaling/disinfection of nebulizers and nasal irrigators), ensured the removal of Legionella spp. and P. aeruginosa and a satisfactory microbiological quality over time. The environmental surveillance was successful in evaluating the hazard and identifying the most suitable preventive strategies to avoid Legionella re-growth. Ultrafiltration is a technology to take into account in the control of microbial contamination of therapeutic spas, since it does not modify the chemical composition of the water, thus allowing it to retain its therapeutic properties. [ABSTRACT FROM AUTHOR]

Aims This study aimed to investigate the prevalence of Simkania negevensis in the chlorinated water of spa swimming pools and domestic network systems. Methods and Results A total of 10 and 36 samples were collected from two domestic water supplies and four spa facilities, respectively. Simkania negevensis was isolated in Acanthamoeba castellanii monolayers and detected by Gimenez staining and immunofluorescence test. Simkania negevensis DNA, extracted from the positive samples, was confirmed by a nested PCR assay followed by sequencing. Simkania negevensis was detected in 41·3% of samples (domestic water: 50%; untreated spa supply water: 25%; chlorinated spa pool water: 42·9%) from all the examined water systems in successive samplings performed in 1 year. The presence of S. negevensis was not correlated with the counts of Heterotrophic Bacteria and Pseudomonas aeruginosa. Unlike Legionella spp., which were never isolated from the swimming-pool water samples, S. negevensis was also detected in chlorinated spa water. Conclusions This investigation shows that Simkania is widespread in natural and man-made aquatic environments, which may represent possible sources of infection: in the swimming pools, in particular, the aerosol generated by the water movement could increase the risk of inhalation of infected particles. Significance and Impact of the Study This study represents the first evidence of the presence of S. negevensis in spa pool water. Sero-epidemiological surveys on spa users could help to clarify its transmission in this environment. [ABSTRACT FROM AUTHOR]

Background: Evidence links sedentary behaviours (SB) with poorer health outcomes; i.e. higher screen time is associated with poorer fitness and cardiometabolic health, as well as unfavourable measures of adiposity, mental health and social behaviour in children. The WHO guidelines for children recommend reaching at least an average of 60 min per day of physical activity (PA). Several studies show a correlation between parental education (PE) and children PA levels. This study aims to analyse the influence that PE has on childrens’ sedentary lifestyle and PA habits in Italian society. Methods: We conducted a cross-sectional analysis among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) in 2017. Children’s and parents’ information were collected at baseline (i.e. age, BMI, occupation, instruction). PA level and SB were evaluated using a weekly diary investigating screen time (PC and TV), sports practice and active play (i.e: running, jumping, riding a bike, etc.). We investigated the relationship between lifestyles and PE (high school degree or lower vs college degree or higher) through multiple linear regression models adjusted for age and gender. Results: Our models show that fathers’ educational level is not related to children’s SB. PA habits and weekly sports activities are not related to PE. On the other hand, higher mothers’ educational level shows to be linked to a decreased TV screen time (p = 0.003) and time spent using a computer (p = 0.035). Notably, older children spend more time using PCs or devices (p = 0.001), net of confounding variables. Conclusions: Our findings show that mothers’ educational level positively influences children’s lifestyle. This result might be related to the fact that, in the Italian context, mothers are usually the principal children’s caregiver influencing their daily routine. In light of this, mothers might be considered a primary target when implementing public health interventions to reduce children’s SB. [ABSTRACT FROM AUTHOR]

Background: Scientific evidence widely argues that consuming breakfast daily is considered a good habit which positively affects health and academic performance, especially in children. In order to be adequate, according to national requirements, breakfast should include a portion of milk or yogurt and one grain based product, providing about 15-20% of the daily recommended energy intake. The aim of this study was to analyse breakfast habits in a convenience sample of primary school children inside the Imola Active Breaks Study. Methods: A cross-sectional study was conducted in a sample of children, aged 6-10, recruited in a primary school of Imola (Emilia Romagna region, Italy). The Zoom8 self-reported questionnaire, which investigates dietary habits and lifestyle aspects were administered to parents to explore the children’s breakfast habits. Results: A total of 155 children were recruited in November 2019. Breakfast was consumed daily by 117 children (75%), 4-6 times/week by 12 (7%), 2-4 times/week by 4 (3%), and 22 (14%) did not answer. Concerning dairy products’ consumption: 50 (32%) children reported milk or yogurt, 47 (30%) milk, 6 (4%) yogurt, 9 (6%) neither of them and 43 (28%) gave no answer. Mostly all the children consumed at least one of these products: biscuits, cakes, croissants, industrial snacks or cereals. 108 children (70%) recognised that the consumption of a dairy and a carbohydrate product represent an adequate breakfast. Conclusions: The findings suggested that the majority of children consumed one grain based product for breakfast, but most of them were high in sugar and fat content (industrial snacks and croissants). Still not every child had breakfast daily nor had a portion of a dairy product. Measurements should be taken to avoid skipping breakfast and to promote a more balanced breakfast. It would be advisable to analyse in detail the frequency of consumption of each food group and their energy intake. Key messages: · Breakfast consumption positively affects children’s health and academic performance. · Health Promotion should stimulate daily consumption of breakfast and improve its quality and energy intake. [ABSTRACT FROM AUTHOR]

Background: Mediterranean diet (MD) is considered a healthy dietary model with several beneficial effects. A strict adherence to the MD in children, coupled with daily exercise, can prevent obesity and significantly reduce the risk of correlated chronic diseases, such metabolic syndrome. The aim of this study is to evaluate the association between parents’ educational level and compliance to the MD in a convenience sample of Italian children. Methods: We conducted a cross-sectional study among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) between May and June of 2017. Children’s and parents’ information were collected at baseline (i.e. age, BMI, occupation, educational level). A weekly food diary was administered to evaluate the participant’s dietary habits. The degree of adherence to MD was derived from these diaries using the KIDMED index developed in 2003 by Serra-Majem et al. We used multiple linear regression models, adjusted for age and gender, to investigate how parents’ educational level affected children’s KIDMED index. Results: Adherence to the MD was high, medium and poor in, respectively, 4%, 60% and 36% of children. Higher prevalence of overweight and obesity was observed among those with lower adherence to the MD. The linear regression model shows that fathers’ educational level is not associated to children’s KIDMED index variation. On the other hand, a higher mothers’ educational level is linked to an increased weekly KIDMED index (p = 0.012) as well as an increased weekend KIDMED index (p = 0.048). Conclusions: Mothers’ education level is associated with increased adherence to MD, both weekly and weekend. The greater difference has been observed during weekend, when children of highly educated mothers score higher at KIDMED index. Key messages: Mothers’ educational level plays an important role in children’s eating habits, with higher educational level associated with a better adherence to the MD. It is critical to implement parents’ toolkit to promote healthy dietary patterns and adherence to MD in order to correct these social differences. [ABSTRACT FROM AUTHOR]

Abstract: The swimming pool legislation is extremely various and uneven. This diversity is related to the different approaches of individual health authorities, attributable to the different social, economic and cultural conditions of each country. In Italy the regulation about sanitary aspects for the construction, maintenance and control of swimming pools refers to the Agreement of January 16, 2003 among the Ministry of Health, the Regions and the Autonomous Provinces of Trento and Bolzano. The Agreement is not a jurisprudential act, but has the character of a document approved by constitutional organs of the same level, aimed to promote the harmonization of respective legislations or the attainment of unitary positions. The controls and the related samples will be collected by Local Health Authority in compliance with criteria established by each region on the basis of specific control plans and supervision and in a manner and frequency that take into account the type of existing facilities inside the specific territorial areas, with particular attention to the critical points highlighted in the protocols of management and the self-prepared safety plans. In this regard, the working Group of Movement Sciences for the Health (GMSH) of the Italian Society of Preventive Medicine and Hygiene (SItI), proposes a checklist to complete during inspections routinely conducted by Local Health Authorities in swimming facilities. The aim is to have a single tool that can homogenize supervisory activities, procedures and types of controls in different realities, both locally and nationally. [Copyright &y& Elsevier]

Introduction: Physical activity (PA) is a modifiable lifestyle factor which contributes to improve pregnancy and perinatal outcomes. Therefore, pregnant women (PW) without contraindications should practice 150 minutes of moderate PA per week, according to the World Health Organization (WHO) guidelines. Nevertheless, a reduction of PA throughout the gestational period appears to be worryingly common. The aim of this survey was to analyse the feasibility of the WHO recommendations, investigating PW and midwives' perceptions towards PA during pregnancy, in a view to enhance future PA interventions. Methods: A total number of 4 focus groups, involving 10 midwives (aged 43-61) and 10 PW (aged 30-46), recruited at the University Hospital of Bologna, were carried out between July 2020 and April 2021. Due to SARS-CoV-2 restrictions, all meetings were held online, recorded, transcribed and then analysed using the COM-B model. Results: WHO recommendations were deemed feasible by both midwives and PW when time management skills and capabilities to adapt PA to individual needs were present. Clearly, women with a background in PA practice tend to be highly motivated thereby maintaining the PA routine also during pregnancy. Both groups reported that PA represents a positive element for the mother's and baby's well-being, triggering a virtuous circle and increasing motivation. Being able to access and perform simple, structured, evidence-based activities, family support, and using every opportunity to be less sedentary were reported as key aspects amongst opportunities to improve PA levels. Conclusions: Positive perception regarding feasibility of the recommendations was similar between groups; nevertheless, midwives perceived pregnancy as an opportunity to change PA routines, while PW considered pregnancy a less dynamic period. Therefore, implementing PA promotion involving midwives might represent a good strategy given their central role during this woman' unique period. Key messages: WHO physical activity recommendations are overall deemed feasible, but tailored opportunities and strategies tackling everyday obstacles and lack of information need to be provided. Enhancing PA is a key challenge for pregnant women in a view of their own and baby's health. The COM-B model can be used to implement new strategies involving midwives to reach the goal. [ABSTRACT FROM AUTHOR]

Background: Children's Health-Related Quality of Life (HRQoL) has been frequently investigated, in particular among individuals affected by chronic diseases. It is reported that agreement between child and parent ratings regarding the child's HRQoL is strongly influenced by the latter's health status. To our knowledge, there is no evidence of how this agreement is related to different healthcare settings. Thus, our study aims to examine the relationship between child's and parent-proxy reported HRQoL of similar overweight/obese children according to the recruitment setting. Methods: A cross-sectional study was conducted among 68 overweight/ obese children, aged 6-10, recruited in a primary school (Group1, G1) and in a hospital outpatient clinic (Group2, G2) of Imola (Italy) in 2019. HRQoL was assessed using Italian version 4.0 of the Pediatric Quality of Life (PedsQL) questionnaire. For each child, we obtained self-reported children's and parents' perceived children's HRQoL total score (5 questions investigating Physical Health domain and 10 questions investigating Psychosocial Health domain divided in Emotional, Social and School Functioning). Results: In G1 there were n = 42 overweight/obese children and in G2 n = 26. The correlation between children's reported and parents' perceived HRQoL scores is lower in G1 (Physical Health: r=-0,17; Psychosocial Health: r = 0.38) compared to G2 (Physical Health: r = 0.80; Psychosocial Health: r = 0.66). Notably, in G1, parents tend to overestimate their children's HRQoL, specifically in the Physical Health domain. Conclusions: Correlation between children's and parents' HRQoL scores is higher in the clinical setting compared to the school setting. Implementing this questionnaire on a large scale would allow us to identify settings which need awareness-raising initiatives to improve parents' knowledge about their children's health. Key messages: Parents' overestimate children's HRQoL in the school setting, particularly in the Physical Health domain. Children's HRQoL misinterpretation might determine less targeted actions to improve their wellbeing and highlights the need for raising parents' awareness about obesity and its effects on children. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis (OP) is a major and increasing health problem worldwide, especially in European countries, where the modern, sedentary lifestyle from an early age leads to brittle bones later in life. Patients affected by OP tend to move less and have a lower quality of life (QoL). This study aims to evaluate how OP affects individual markers for QoL in postmenopausal women and assess the influence of exercise on these markers. Methods: The EQ-5D questionnaire was administered to evaluate Mobility, Self-care, Usual Activities, Pain/Discomfort and Anxiety/Depression in a sample of Italian women with osteoporotic vertebral fractures, aged 60-75. Markers linked to QoL were compared for these women with those of an average female Italian population (AFIP) of similar age. Concurrently, a 6-month exercise trial was conducted, in which the OP patients were divided into two groups: an exercise group (EG) and a control group (CG). The QoL was assessed for both groups at the end of the trial. Results: A larger proportion of OP patients reported some problems with Mobility as compared to the AFIP (37.5% versus 31.2% respectively, p = 0.001) and in performing Usual Activities (45% versus 23.9%, p = 0.002). OP patients (77.5%) experienced some Pain/Discomfort, compared to 48.1% of the AFIP (p = 0.001). Anxiety/Depression was reported by 40% of OP patients and 18.8% of the AFIP (p = 0.001). Concerning the exercise trial, the results indicated a positive trend for Mobility and Usual Activities in the EG, while the CG markers remained unchanged. Conclusions: Overall, results confirm that OP significantly affected QoL in postmenopausal women. In particular, OP negatively influenced the markers Mobility, Usual Activities, Pain/Discomfort and Anxiety/Depression. Exercise programs tailored to OP patients can improve some markers linked to QoL. Evidence suggests that health policy makers in Europe can consider including OP-adapted exercise programmes in guidelines for OP management. Key messages: Osteoporosis negatively affects the quality of life for postmenopausal women. In particular, Mobility, Usual Activities, Pain/Discomfort and Anxiety/Depression markers were affected. Exercise can improve some markers linked to quality of life (Mobility and Usual Activities). Thus, it could be proposed as a treatment for osteoporosis in postmenopausal women. [ABSTRACT FROM AUTHOR]

Background: Between 15 and 50% of European children aged 6-9 are overweight or obese and this number is rising dramatically over time, making it one of the most important public health challenges. Selection of healthy food and a balanced diet are key when addressing this obesity epidemic. At the same time, it is essential to consider schools’ role and parents’ influence on children’s dietary habits. This study aims to assess the adequacy of meals during the weekdays (WD) and weekends (WE), therefore highlighting the critical moments where schools’ and parents’ involvement needs to be of greater impact. Methods: A cross-sectional study was conducted among 428 children aged 6-11 recruited in a primary school of Calderara di Reno (Italy) in 2017. A weekly diary was administered between May and June 2017 to explore the dietary habits of the participants. Every day for each meal (breakfast, morning snack, lunch, dinner) it was required to report what types of food and beverages were consumed, and where (home/school). The adequacy of each meal was determined by using national guidelines. A McNemar test was performed to evaluate the differences in meal adequacy between the WD and WE. Results: Our analysis showed that meals consumed at school, i.e. morning snacks and lunches, were more adequate during WD than WE (69.6% vs 22.2%, 53.5% vs 32.5%; P-value <0.001), underlying the positive influence of school. On the other hand, breakfasts and dinners were more adequate during WE than WD (64.5% vs 51.4%, 23.8% vs 15.7%; P-value <0.001); this difference might be partially explained by the different amount of time parents have for food preparation during workdays versus weekends. Conclusions: Further preventive interventions should address childrens’ and parents’ home dietary routine as a tool to improve meal adequacy at home and therefore reduce childhood obesity. Parental school-based interventions could have a key role in changing childrens’ dietary habits. Key messages: • Our study showed a significant difference of healthy dietary habits between meals served at school during weekdays and at home during weekends, highlighting a higher dietary adequacy in the first ones. • The results underline the importance of implementing educational programs addressing childrens’ and their parents’ home meals routine and dietary habits. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak has forcibly overshadowed the physical well-being of children and adolescents, of which we will see the consequences in near future. The programs to contain the spread of Sars-CoV-2 resulted in prolonged lockdown periods, discontinuity of educational services and a possible decrease in physical activities (PA) among the youngest. In the local reality of the Metropolitan City of Bologna children and adolescents underwent a radical change in habits and lifestyle, overall predisposing sedentariness and unhealthy behaviors. Our project, ‘‘Come te la passi?’’, aims to acknowledge lifestyle variations (concerning diet, PA, sleep behavior/quality) to design, in second-phase interventions, individualized school-based educational programs. Methods: This ongoing study is being conducted using an on-line anonymous questionnaire targeting parents/guardian of children and adolescents aged 6-17 recruited from 26th to 28th of April in Bologna, a city in Northern Italy. Results: Preliminary data suggested that among adolescents (n = 124) 91.2% used to do PA 2 or more times a week before lockdown, while during lockdown this percentage decreased, reaching 41.1%. In children (n = 38) we observed an even more pronounced difference, with PA decreasing from 89.5% to 26.3%. In children 29% of the participants also reported a weight gain, while 65.8% did not report any variation and only 5.2% reported a weight loss. For the majority of both children’s and adolescents’ parents (n = 162), the strategies to address the reduction in PA were predominantly having school time dedicated only to PA (53.1%) and being more educated about simple physical exercises (14.5%). Conclusions: Our preliminary findings suggest that the current pandemic had a strong impact on the well-being of children and adolescents; ‘‘Come te la passi?’’ second-phase interventions could be crucial in addressing the youngest’ needs, to educate and promote healthier lifestyles through school-based programs. Key messages: Children’s and adolescents’ lifestyle behaviors were strongly affected by the current pandemic, with physical activity frequency more than halved. ‘‘Come te la passi?’’ objectives are to frame the major critical issues detected and to shape educational school programs based on identified needs. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak has forcibly overshadowed the physical well-being of children and adolescents, of which we will see the consequences in near future. The programs to contain the spread of Sars-CoV-2 resulted in prolonged lockdown periods, discontinuity of educational services and a possible decrease in physical activities (PA) among the youngest. In the local reality of the Metropolitan City of Bologna children and adolescents underwent a radical change in habits and lifestyle, overall predisposing sedentariness and unhealthy behaviors. Our project, ‘‘Come te la passi?’’, aims to acknowledge lifestyle variations (concerning diet, PA, sleep behavior/quality) to design, in second-phase interventions, individualized school-based educational programs. Methods: This ongoing study is being conducted using an on-line anonymous questionnaire targeting parents/guardian of children and adolescents aged 6-17 recruited from 26th to 28th of April in Bologna, a city in Northern Italy. Results: Preliminary data suggested that among adolescents (n = 124) 91.2% used to do PA 2 or more times a week before lockdown, while during lockdown this percentage decreased, reaching 41.1%. In children (n = 38) we observed an even more pronounced difference, with PA decreasing from 89.5% to 26.3%. In children 29% of the participants also reported a weight gain, while 65.8% did not report any variation and only 5.2% reported a weight loss. For the majority of both children’s and adolescents’ parents (n = 162), the strategies to address the reduction in PA were predominantly having school time dedicated only to PA (53.1%) and being more educated about simple physical exercises (14.5%). Conclusions: Our preliminary findings suggest that the current pandemic had a strong impact on the well-being of children and adolescents; ‘‘Come te la passi?’’ second-phase interventions could be crucial in addressing the youngest’ needs, to educate and promote healthier lifestyles through school-based programs. Key messages: Children’s and adolescents’ lifestyle behaviors were strongly affected by the current pandemic, with physical activity frequency more than halved. Come te la passi?’’ objectives are to frame the major critical issues detected and to shape educational school programs based on identified needs. [ABSTRACT FROM AUTHOR]