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Background: In Italy, leprosy diagnosis is reported in immigrants from endemic countries or Italians who have stayed in endemic areas. We report the first leprosy case to be observed in a migrant from Nigeria in the Rimini district (Emilia-Romagna, Northern Italy)., Methods: After describing the tasks of the various health Institutions in the Italian integrated system for diagnosis, treatment, and surveillance of leprosy, we describe the management and outcomes of the leprosy case and of the patient's contacts., Results: In April 2017, Multibacillary Lepromatose Leprosy was diagnosed in a 29-year-old Nigerian man who arrived in Rimini in July 2014 after a 2-year stay in Libya. The local Public Health Service implemented the epidemiological investigation and identified the patient's close contacts. The management of the case and the surveillance of the 13 identified contacts, 7 Italians and 6 migrants, highlighted some critical issues. The late diagnosis of the case, due to the lack of knowledge of exotic diseases by general practitioners and other health and social professionals, and the loss at follow up of the close contacts (5 out of 6 migrants), represented important obstacles to the full success of surveillance measures., Conclusions: Although in Italy there is a well codified system of notification and surveillance of leprosy, the recognising of cases and the tracing and follow up of contacts are made difficult by the particular conditions of the involved people. This represents a new challenge for the Italian Public Health Authorities which, in the current context of immigration, often uncontrolled, must know how to respond to the new needs, in close collaboration with the State Institutions responsible for registering migrants and those health and social professionals who could facilitate the access of foreign people to health services.

Background: A school based health promotion intervention was performed with the aim of increasing physical activity and improving the dietary habits of primary school pupils, using integrated educational strategies involving schools, families, public bodies, sports associations and public health operators., Methods: The intervention concerned 11 classes during 3 school years from 2009-10 (231 third-year school children) to 2011-12 (234 fifth-year school children). Information was collected both before and after the intervention about the dietary habits and the physical activities practised by the children, using the questionnaires of the project !OKkio alla Salute! which were administered to both children and parents. At the same time anthropometric measurements were taken (height, weight, BMI) and motor skills were assessed using standardized tests: Sit & Reach, medicine-ball forward throw, standing long jump, 20 m running speed, and forward roll. At the end of the intervention 12 different expected outcomes were assessed (5 about dietary habits, 5 about motor habits, 1 about anthropometric characteristics, 1 about motor skills)., Results: At baseline, 35.8% of the children show excess weight (23.4% overweight; 12.4% obese); this percentage falls to 29.3% (25.3% overweight; 4% obese) after the intervention (p <0.05). The dietary habits improve from the pre- to the post-intervention: there is a rise in the percentage of children who receive an adequate mid-morning snack (p <0.0001), a fall in the percentage of children who consume snacks and drinks after the dinner (p <0.01), and an increase in the percentage of those who take five or more portions of fruits and vegetables daily. The motor habits do not improve in the same way, since there is the increasing tendency with age to skip from a regular daily practice of physical exercise to favour of the occasional practice of a sport. The motor performances, compared after normalization for modifications due to the process of growth, improve between the third and fifth years of primary school, but with no significant differences. To achieve this objective more focused measures are necessary in the administration of moderate to intense physical exercise., Conclusions: The results point to a positive assessment of the intervention, thus highlighting the importance of planning integrated and multisectorial actions in school-based programmes to promote correct dietary and motor habits and for the control of body weight, also involving non scholastic areas.

A randomized stratified sample of 522 children attending the third class of primary schools within the area of Bologna Local Health Unit was analysed for physical activity and sports practice. Information about the children's habits and availability of facilities for physical and sports activities were collected by means of structured questionnaires completed by children (507 respondents), parents (491), reference teachers for physical education (26) and class teachers (46) during the school year 2006-07. At the same time, the children's heights and weights were measured in order to calculate BMI values. Regular sports activity is practised by 80.1% of children (males: 82.4%, females: 77.6%), with significant diferences between genders only in children with at least one non-Italian parent (M>F, p < 0.05); the practice of sports is influenced by the area of residence (metropolitan > plain and hills, p < 0.05) and nationality (Italians > non-Italians, p < 0.01). Children with at least one actively sports practising parent are involved more frequently in sports activities (p < 0.001). In free time, sedentary activities are prevalent for both sports-practising children and not. However children not involved in regular sports activities tend to practise outdoor physical activities with a frequency significantly higher than children involved in sports (17.3% vs 10.4% of respondents). The percentage of completely sedentary children, who stated that they practise neither sports nor physical activity in their free time, is 7.3% (metropolitan area: 4.5%, hills: 8.7%, plain: 10.6%). The prevalence of overweight is 24.4%, of obesity 9.7%, with a better distribution of BMI values in the metropolitan area where there is the highest occurrence of positive conditions and behaviours: availability of sports facilities, the highest prevalence of sports practice, and the lowest prevalence of completely sedentary children.

The hygienic characteristics of the freshwater from Garda Lake used for the water supply of Sirmione were evaluated before and during the various phases of treatment. The samples were taken at the moment of entry, after ozonization, after filtration and after the addition of chlorine dioxide. The coliforms and Escherichia coli, occasionally detected in the incoming water, were reduced by ozone and eliminated by filtration. Enterococci were always absent. The overall reduction in the total bacteria count was satifactory, considering the low initial levels (96.0% and 83.0% respectively for the Heterotrophic plate count at 22 degrees and the Heterotrophic plate count at 36 degrees). The chemical and physical indicators that underwent the greatest reductions were the sulphates, iron, manganese, ammonia and the turbidity. Several species of unicellular algae belonging to Chlorophyta, Cyanophyta and Bacillariophyta were identified in the water at entry and after ozonization, but were completely eliminated during the subsequent phase of filtration. deliver of high quality services.

A bicarbonate-sulphate-calcic water of a therapeutic spa was monitored for the presence of Legionella, Pseudomonas and Mycobacteria. The water was analysed by taking samples from the well, the feed tank and from the final aerosol generating devices of two different water lines, the former at 21-23 degrees, the second at 36-38 degrees. The bacteria in question were always absent from the well. Legionellae were found in the water of aerosol equipment: Legionella micdadei was isolated from 75% of samples, L. bozemanii from 75% and 50% (respectively 36-38 degrees and 21-22 degrees water lines) and other species of environmental Legionellae from 25% of samples. The water of aerosol equipment presented high total bacterial counts (10(3)-10(4) cfu/ml) and exspecially high concentrations of Pseudomonadaceae (10(2)-10(3) cfu/100 ml). These bacteria, unlike the Legionellae, were also isolated from the feed tank at mean concentrations of about 10(2) cfu/100 ml. Mycobacteria were found in 75 and 50% of samples collected from final devices, respectively from the heated and not heated water lines. The isolates were M. gordonae (85% of isolates) and M. fortuitum (15%), but at concentrations very low. Both treatments with sodium hypochlorite (20 ppm of residual chlorine) and peracetic acid (20 ppm) resulted in the reduction of total bacterial counts and elimination of Pseudomonas from the water in the tank, but not in elimination of Pseudomonas and Legionellae from the nebulizers. The disinfectants were evidently not able to efficiently reach all the points where Pseudomonas and Legionella had settled and grown. In order to obtain total abatement it was necessary to carry out a radical restructuring of the plant, involving the replacement of the old nebulizer benches with new aerosol equipment that could be subjected to a new system of programmed thermal shock.

A multicentric Italian investigation on legionnaires' disease is in course to clarify host factors as well as pathogen associated characteristics involved in the infection/disease. The main goal of the research plan is to account for some critical aspects concerning identification and prevention of legionellosis. To improve knowledge on factors associated with Legionella spp colonisation in hot waters, to detect cases and to characterize risk factors in subjects which develop pneumonia are specific objectives of the research programme. Preliminary results show that hot waters of houses and hotels are frequently contaminated (22.6% and 54.6%, respectively), mainly by L. pneumophila. Microbial concentrations were low in domestic waters (<1.000 ufc/l), but higher in samples from the hotels (geom. mean 1.85 x 10(3) ufc/l). Warming system, age of the plant, type of building were risk factors significantly associated with Legionella spp positivity. The active surveillance on patients affected by pneumonia with search for Legionella urinary antigen allowed the identification of 34 cases, 3 of which of nosocomial origin, corresponding to 4.2% of the screened pneumonia. After informed consent, 26 subjects were recruited for a case-control-study to clarify risk factors for the disease.

A 5 years survey (1996-2000) was performed on the microbiological quality of shellfish (mussels and clams) collected from authorized shellfish-growing area of the North Adriatic Sea (province of Rimini). 7.0% of mussel samples (33/474) and 21.9% of clam samples (218/996) exceeded the legal limits for faecal indicators (Dlgs 530/92). The faecal contamination of shellfish was related to the organic pollution arriving from inland surface waters. In fact shellfish harvested near the coast were more contaminated, as well as shellfish grown in the surface layers of the open sea, where the fresh waters of the streams tend to stratify. Faecal contamination was also directly correlated with rainfall, probably because the atmospheric precipitation, increasing the flow of the streams, favoured the transport of organic substances and micro-organisms deriving from the soil washing and the municipal sewage effluents. Furthermore, when rainfall was particularly plentiful, sewage inflow could also exceed the hydraulic capacity of the treatment plants; thus making necessary to discharge untreated waste directly into surface waters. Salmonellae were found in 0.7% of clam samples. Although this percentage is very low, it shows that pathogenic micro-organisms are present in this area of sea. This finding, together with the high variability of shellfish pollution due to occasional factors as rainfall, emphasise the importance of the systematic monitoring of the microbiological quality of shellfish.

In Italy the mortality rate for gastric cancer is still very high compared to that of other European countries, with marched differences between the regions (age-adjusted rates were much higher in the North than in the South). On the basis of official certifications, gastric cancer ranks as the second cause of death from cancer in both sexes, only surpassed by tumors of respiratory tract in men and breast cancer in women. This note examines the data relative to the official death certifications for stomach cancer in Italy, between 1950-1982, to value quantitatively the trend of the mortality in the last years as regards sex, age and birth year. The absolute values relative to death certifications for gastric cancer between 1950 and 1982 were obtained from the Istituto Centrale di Statistica which gathers all the death certifications issued throughout the whole of Italy. The 1951-1961-1971-1981 census data were used to calculate the rates for 100,000 inhabitants. For the thirty years considered, the following rates were calculated separately for each sex: a)--the age-specific mortality rates for five-year age groups in the three years around the census; b)--the age-adjusted mortality rates (direct methods, using the Italian population of the October 1981 census as standard population) for the total population and for those aged between 35 and 74; c)--the age-specific mortality rates in five-year age group, by cohorts of birth from 1883-85 to 1933-35; d)--the male/female ratio for gastric cancer mortality. Age-standardized death certification rates for the population of all ages decreased from 51.7 to 32.9/100,000 males and from 40.3 to 21.5/100,000 females. Age-standardized death truncated 35-74 years mortality rates showed a more marked declining trend in both sexes: from 92.5 to 50.1/100,000 males and from 57.3 to 23.3/100,000 females. If differences among the age-specific mortality rates between 1951 and 1981 is examined, it can be seen that there is a constant more or less marked decline for all the age groups up to 74, whereas in the higher age groups the rates tend to increase. The analysis of the cohorts of birth reveals that the decline in mortality rates for stomach cancer was already evident in females born at 1894 and in males born at 1904 and this continued regularly in the following decades. Finally, the trend male/female ratio for gastric cancer mortality increased over time from 1.28 in 1951 to 1.53 in 1981.(ABSTRACT TRUNCATED AT 400 WORDS)