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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.

Tattooing and piercing may lead to health complications. The present multicenter cross-sectional study aimed to assess awareness and knowledge of health risks related to body art and to identify their possible determinants among a large sample of undergraduates in Italy. A web-based questionnaire collecting information on socio-demographic characteristics, awareness, knowledge, and some potential predictors was administered to undergraduates attending twelve Italian universities. The level of knowledge was expressed as the number of correct answers (0–11 for tattooing, 0–14 for piercing). A total of 2985 participants (mean age 23.15 ± 3.99, 73.9% F) participated in the study. Although 95.4% of the respondents were aware of possible health consequences of body art, a low level of specific knowledge was registered for both tattooing (mean number of correct answers 5.38 ± 2.39) and piercing (5.93 ± 3.12) consequences. Lower knowledge was associated with the attendance of non-life science course and with lower duration of academic education for both tattoo and piercing. Lower knowledge of tattooing risks was related with commuter status, while lower knowledge of piercing risks was associated with lower father’s education. These findings highlight the need to enhance information campaigns targeted to youths to increase their awareness of possible health risk of body art.

Background: Regular physical activity (PA) practice during pregnancy offers health and fitness benefits for both mother and baby. Therefore, healthy pregnant women with no contraindications to exercise should be encouraged to perform PA. Nevertheless, their levels of PA are generally low. The aim of the WELL-DONE! Study is to co-design an adapted physical activity intervention (APAI) for pregnant women to include in childbirth preparation classes (CPCs) evaluating its feasibility and efficacy on quality of life (QoL), PA levels and other outcomes. Methods: A quasi-experimental study was divided in two progressive stages. First, APAI was developed in collaboration with pregnant women and midwives using focus groups; second, APAI’s efficacy was evaluated comparing two groups: the experimental group engaged in the CPCs integrated with 1 h/week of the APAI administered by midwives and the control group participating in the standard CPCs. Pre-post evaluation was carried out in three stages through questionnaires and tests. Data analysis involved the combination of qualitative and quantitative methodologies. Discussion: Findings from the WELL-DONE! Study will help to assess the feasibility, sustainability, and efficacy of incorporating APAI inside CPCs as a new public health strategy oriented to QoL, well-being, and PA level improvements.

The process of bone loss occurs silently and progressively with age, often appearing as osteopenia or osteoporosis or related fractures. Given the rapid raise in disease burden and socio-economic costs of these conditions worldwide, drug therapy combined with physical activity can be a useful strategy and bone biomarkers, can represent a useful evaluation tool to assess their effects. The objective of this systematic review, conducted according to PRISMA statement, was to investigate the effects of physical activity interventions combined with drug treatments on bone biomarkers in people with osteopenia and osteoporosis. Through PubMed, Cochrane, Cinahl, Embase, Trip, a comprehensive literature search was performed. Each study’s quality was assessed according to the Cochrane risk-of-bias tool. Out of 582 identified articles, 50 full texts were screened. Only one matched the eligibility criteria. The study, scored as high quality, showed, in both experimental and control groups, an increase of CTX and P1NP bone biomarkers, without statistically significant differences. Based on available evidence, no exhaustive conclusion can be drawn. However, this systematic review critically analyses the literature, highlighting the knowledge gap on combined treatments efficacy assessed by bone biomarkers. Moreover, an outlook is provided for the planning of future studies.

In the near future, COVID-19 vaccine efficacy trials in larger cohorts may offer the possibility to implement child and adolescent vaccination. The opening of the vaccination for these strata may play a key role in order to limit virus circulation, infection spreading towards the most vulnerable subjects, and plan safe school reopening. Vaccine hesitancy (VH) could limit the ability to reach the coverage threshold required to ensure herd immunity. The aim of this study was to investigate the prevalence and determinants of VH among parents/guardians toward a potentially available COVID-19 vaccination for children and adolescents. An online survey was performed in parents/guardians of children aged &lt, 18 years old, living in Bologna. Overall, 5054 questionnaires were collected. A vast majority (60.4%) of the parents/guardians were inclined to vaccinate, while 29.6% were still considering the opportunity, and 9.9% were hesitant. Highest vaccine hesitancy rates were detected in female parents/guardians of children aged 6–10 years, ≤29 years old, with low educational level, relying on information found in the web/social media, and disliking mandatory vaccination policies. Although preliminary, these data could help in designing target strategies to implement adherence to a vaccination campaign, with special regard to web-based information.

Background: Children and adolescents should perform, according to the World Health Organization guidelines, at least 60 min of moderate-to-vigorous physical activity per-day in order to avoid the risk of metabolic and cardiovascular diseases. The school represents a fundamental setting to conduct interventions to promote physical activity (PA) and contrast sedentary behaviors. Active breaks (ABs), bouts of 10 min of PA conducted inside the classroom, seem to be a good strategy to promote PA and improve classroom behavior. The aim of this study protocol is to describe the design and the assessment of the Imola Active Breaks I-MOVE study. Methods: The I-MOVE study is a school-based intervention trial, with a quasi-experimental design, performed in a primary school. It involves one experimental-group performing the intervention, focused on ABs, and one control-group. Nine main outcomes are evaluated: PA and sedentary behaviors; health related fitness; motor control development; dietary patterns; anthropometric evaluation; sociodemographic determinants; cognitive function; time-on-task behavior and quality of life. Conclusions: Results from the I-MOVE study will help to clarify the effects of incorporating ABs in the Italian school curriculum as a new public health strategy and an innovative school model oriented to the well-being of children and teachers for the best quality of school life.

Background: The school gives access to children, regardless of age, ethnicity, gender and socio-economic class and can be identified as the key environment in which to promote children&rsquo, s physical activity (PA). The guidelines of the European Union recommend accumulating at least 10-min bouts of PA to reach the daily 60 min. Active breaks (ABs) led by teachers inside the classroom represent a good strategy to promote PA. The aim of this pilot and feasibility study was to evaluate the feasibility and effectiveness in terms of PA level of an AB programme in children aged 8&minus, 9 years attending primary school. Methods: A pre-post quasi-experimental pilot and feasibility study was performed in two primary school classes, one of which was assigned to a 14-week AB intervention (AB group) and the other to the control group (CG). At baseline and at follow-up, children were monitored for sedentary and motor activity during an entire week using ActiGraph Accelerometer (ActiLife6 wGT3X-BT). The satisfaction of children and teachers was assessed by self-administered questionnaires. Results: In the pre-post comparison, AB group (n = 16) showed a reduction in the minutes spent in weekly sedentary activity (-168.7 min, p &gt, 0.05), an increase in the number of step counts (+ 14,026.9, p &lt, 0.05) and in time spent in moderate to vigorous PA (MVPA): weekly MVPA: + 64.4 min, daily MVPA: + 8.05 min, percentage of MVPA: + 0.70%. On the contrary, CG showed a worsening in all variables. ANCOVA analysis, after adjusting for baseline values, showed significant differences between the AB group and CG for time spent in MVPA, percentage of MVPA and step counts. The satisfaction of children and teachers was good. Teachers were able to adapt the AB protocol to the needs of the school curriculum, thus confirming the feasibility of the AB programme. Conclusions: This pilot and feasibility study showed the feasibility and effectiveness of the AB protocol and represented the basis for a future controlled trial.

A quasi-experimental pilot study was performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol and its effect on health-related quality of life (HRQOL), fear of falling, pain, and physical performance in women with osteoporosis-related vertebral fractures. Forty-four post-menopausal women (mean age: 67.6 &plusmn, 4.6) with osteoporotic vertebral fractures were assigned to an exercise group (APA group = 26) who attended a six-month exercise protocol that included postural and muscular reinforcement exercises, and a control group (CG = 18) who was asked to maintain their current lifestyle. At baseline and six months after baseline, HRQOL was measured as primary outcome by the Assessment of Health Related Quality of Life in Osteoporosis (ECOS-16) questionnaire. Secondary outcomes were fear of falling (Fall Efficacy Scale International, FES-I), lumbar back pain (Visual Analogue Scale-VAS), functional exercise capacity (Six Minutes Walking Test-6MWT, Borg scale), balance and gait (Tinetti Scale), and flexibility of the column (Chair Sit-and-Reach). The effects of the intervention were analyzed by comparison within groups and between groups. Effect sizes (ES) were calculated using Cohen&rsquo, s d. All the outcomes significantly improved in the APA group, while they remained unchanged in the CG. After adjustment for unbalanced variables, the comparison between groups showed significant effects of the intervention for ECOS-16-score, functional exercise capacity, balance, and gait. The exercise program had big effect sizes on HRQOL (ES = 1.204), fear of falling (ES = 1.007), balance (ES = 0.871), and functional exercise capacity (ES = 1.390). Good adherence (75.8%) and no injuries were observed. Due to its feasibility, safety, and effectiveness, the proposed exercise protocol can be adopted in APA programs addressed to patients with osteoporosis-related vertebral fractures.

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 In developed countries, scabies is observed sporadically or as institutional outbreaks in hospitals and other health facilities. In the family context, outbreaks generally involve a limited number of cases. Methods A local health authority in Emilia-Romagna (Northern Italy) carried out an epidemiologic investigation on a family outbreak of scabies that included an unusually high number of cases. Its possible connection with a nosocomial case in a long-term care facility (LTCF) and outbreak management are discussed. Results Among the household members, 8 confirmed cases occurred (attack rate, 87.5%). Another case was reported in a patient of an LTCF where one of the family cases worked as a sociosanitary operator. In total, 244 contacts were placed under surveillance. The control strategy focused on a mass information campaign addressed to all contacts and the training of health care personnel. In addition, specific prophylaxis (permethrin 5%) was performed in 108 high-risk contacts and LTCF patients and staff. Conclusions The control measures were successful in preventing the spread of the outbreak. However, misdiagnosis and the tendency of people to hide the symptoms caused the late recognition and underestimation of the cases, contributing to delayed control measures and increasing the economic and human resources required for outbreak management.

Objective. The aim of this study was to assess whether the combination of Adapted Physical Activity (APA) and Therapeutic Patient Education (TPE) improves function and quality of life in survivors of strokes. Methods. This nonrandomized controlled study enrolled patients with mild to moderate hemiparesis referred to 2 physical medicine and rehabilitation units in Emilia-Romagna, Italy, 3 to 18 months after a single unilateral mild to moderate stroke. The experimental group (n = 126) received 16 APA sessions and 3 sessions of TPE, and the control group (n = 103) received usual care; 86.9% completed treatment. The main outcome measure was a 4-month change in gait endurance (that corresponds to 2 months after intervention in the experimental group), and secondary outcomes included the Short Physical Performance Battery, Berg Balance Scale, Barthel Index, Geriatric Depression Scale, 12-item Short-Form Health Survey, and Caregiver Strain Index. Changes in scores at 4 months were compared between groups using analysis of variance and controlling for group imbalance by means of the propensity score. Results. Gait endurance, physical performance, balance, and the physical component of the quality of life score increased significantly at 4 months in the APA group and remained stable in the control group. The propensity-adjusted between-group change was significant for these scores at P < .01. Conclusions. Our results confirm that it is feasible and potentially effective to implement APA programs for elderly patients with complex clinical conditions as early as 3 months after a stroke and suggest that, when combined with TPE, the effects of a postrehabilitation APA program are relatively enduring.

Dallolio L, Menarini M, China S, Ventura M, Stainthorpe A, Soopramanien A, Rucci P, Fantini MP, on behalf of the THRIVE Project. Functional and clinical outcomes of telemedicine in patients with spinal cord injury. Objective To compare the 6-month outcomes of telerehabilitation intervention with those of standard care for spinal cord injury (SCI). Design Multicenter randomized controlled trial. Setting Home, nursing, or unspecialized hospital care provided after discharge from a spinal cord unit. Participants Adult patients with nonprogressive, complete, or incomplete SCI discharged for the first time from the spinal cord unit to their homes (Belgium and Italy) or to their homes or another facility (England). Interventions All patients received the standard care they would have normally received after discharge from the spinal cord unit. In addition, patients in the telemedicine group received 8 telemedicine weekly sessions in the first 2 months, followed by biweekly telemedicine sessions for 4 months. Main Outcome Measures Functional status at 6 months, clinical complications during the postdischarge period, and patient satisfaction. Results No significant differences in the occurrence of clinical complications were found between the study groups. A higher improvement of functional scores in the telemedicine group was found only at the Italian site: FIM total score 3.38±4.43 (controls) versus 7.69±6.88 (telemedicine group), FIM motor score 3.24±4.38 (controls) versus 7.55±7.00 (telemedicine group; P Conclusions Our study provides some of the first quantitative evidence, based on results from 1 site, that telerehabilitation may offer benefits to patients discharged from a spinal cord unit compared with standard care in terms of functional improvement. Further research is warranted to confirm or disprove this finding.

Background:Physical education (PE) can be considered an instrument for active lifestyle promotion, and PE teachers can motivate youths to continue their studies in the field of Movement Sciences (MS).Methods:To evaluate the role of PE in higher secondary school in promoting physical activity (PA) and MS careers, previous PE experiences and current PA practice were investigated in a sample of Italian freshmen enrolled in different university degree courses.Results:A total of 7033 questionnaires were completed by students from 14 universities (41.3% males, mean age 20 ± 2.76 years). Recreation seemed to be the principal aim (42.2%) pursued during PE lessons, which are based mainly on practical activities (51.7%). Of all respondents, 67.2% were satisfied with the PE received during higher secondary school, and 51.6% participated in extracurricular PA. Current practice of PA was reported by 58.1% of the sample. Extracurricular activities were associated with choice of MS curricula (odds ratio: 2.15; 95% confidence interval, 1.85–2.50) and with current practice of PA (odds ratio: 1.68, 95% confidence interval, 1.51–1.87). Geographical differences concerning lessons organization and satisfaction were registered (P < .01).Conclusions:To enhance its role in health promotion, PE teaching should be improved by increasing the time allocated to PE and by strengthening the provision of school-based extracurricular PA.

Output water from dental unit waterlines (DUWLs) may be a potential source of infection for both dental healthcare staff and patients. This study compared the efficacy of different disinfection methods with regard to the water quality and the presence of biofilm in DUWLs. Five dental units operating in a public dental health care setting were selected. The control dental unit had no disinfection system; two were disinfected intermittently with peracetic acid/hydrogen peroxide 0.26% and two underwent continuous disinfection with hydrogen peroxide/silver ions (0.02%) and stabilized chlorine dioxide (0.22%), respectively. After three months of applying the disinfection protocols, continuous disinfection systems were more effective than intermittent systems in reducing the microbial contamination of the water, allowing compliance with the CDC guidelines and the European Council regulatory thresholds for drinking water. P. aeruginosa, Legionella spp, sulphite-reducing Clostridium spores, S. aureus and β-haemolytic streptococci were also absent from units treated with continuous disinfection. The biofilm covering the DUWLs was more extensive, thicker and more friable in the intermittent disinfection dental units than in those with continuous disinfection. Overall, the findings showed that the products used for continuous disinfection of dental unit waterlines showed statistically better results than the intermittent treatment products under the study conditions.

Background This study aimed to assess whether a school-based physical education intervention was effective in improving physical abilities and influencing daily physical activity habits in primary school children. The possible effect on body mass index (BMI) was also considered. Methods Twenty-six 3rd-grade classes were randomly selected stratifying by geographic location (city, plain, hills) and were assigned either to an intervention (127 boys; 120 girls) or to a traditional (129 boys; 121 girls) physical education program. At baseline (age: 8-9 years) and after a 2-year follow-up (age: 10-11 years), information was collected about sport participation and daily activity habits using a self-administered questionnaire. Height, weight, and BMI were measured and physical performance was assessed by means of standardized tests. Results The enhanced program of physical education was effective in improving physical abilities of children and determining a decrease (boys: 10%; girls: 12%) in daily sedentary activities (preintervention versus postintervention, p

INTRODUCTION: The following is a summary of the official guidelines of the Italian Association for the Study of the Pancreas regarding the medical, endoscopic and surgical management of acute pancreatitis. STATEMENTS: Clinical features together with elevation of the plasma concentrations of pancreatic enzymes are the cornerstones of diagnosis (recommendation A). Contrast-enhanced computed tomography (CT) provides good evidence for the presence of pancreatiti (recommendation C) and it should be carried out 48-72 h after the onset of symptoms in patients with predicted severe pancreatitis. Severity assessment is essential for the selection of the proper initial treatment in the management of acute pancreatitis (recommendation A) and should be done using the APACHE II score, serum C-reactive protein and CT assessment (recommendation C). The etiology of acute pancreatitis should be able to be determined in at least 80% of cases (recommendation B). An adequate volume of intravenous fluid should be administered promptly to correct the volume deficit and maintain basal fluid requirements (recommendation A); analgesia is crucial for the correct treatment of the disease (recommendation A). Enteral feeding is indicated in severe necrotizing pancreatitis and it is better than total parenteral nutrition (recommendation A). The use of prophylactic broad-spectrum antibiotics reduces infection rates in CT-proven necrotizing pancreatitis (recommendation A). Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for intervention, including surgery and radiological drainage (recommendation B). CONCLUSIONS: The participants agreed to revise the guidelines every 3 years in order to re-evaluate each question on the management of acute pancreatitis patients according to the most recent literature.

BACKGROUND: Infant mortality rate (IMR) is used as a population health indicator. We provide an updated description of temporal and geographical trends of IMR in Italy. METHODS: Regional data on infant deaths and live births were available for France, Germany, England, Portugal (1999-2000), and Italy (1990-2001). Mortality rates including 95% CIs and time-trends were computed. RESULTS: IMR was 4.5 per 1000 live births in 1999-2001. Between 1999-2001 and 1990-1992 both neonatal and post-neonatal mortality rates declined (P < 0.05) but not the North/South ratio. In 1999-2000 the regional variability in IMR was higher in Italy than in other European countries. CONCLUSION: Despite progresses in reducing IMR, geographical disparities persist within Italy.

BACKGROUND: Infant mortality is a key indicator of child and population health. The aim of this study is to analyse the trends in infant mortality rates (IMRs) and their components (neonatal mortality rates-NMRs and post-neonatal mortality rates-PNMRs) from 1991 to 2009 both at the national level and across the three Italian large geographical macro-areas (North, Center, South). METHODS: Using data extracted from the Health for All-Italy database, IMRs, NMRs and PNMRs were calculated for the 19 Italian Regions and 2 Autonomous provinces for the years 1991-2009. Relative risks and attributable fractions were calculated for Southern and Central Italy compared with Northern Italy. Temporal trends were analysed using the robust polynomial Poisson regression models. RESULTS: During the study period there was a 54% decline in IMR (from 7.72/1000 to 3.55/1000), a 57% decline in NMR (from 5.87/1000 to 2.55/1000) and a 46% decline in PNMR (from 1.85/1000 to 1/1000). In particular, we found a strong decline in IMRs and NMRs from 1991 to 2000/2001, and a weaker decline starting from 2002/2003. Moreover, we found a slight decrease in PNMRs until 2001/2002, and no significant variations starting from 2003. Despite these reductions, important geographical variations persisted: in 2006-2009, the most recent data available, the excess of infant mortality in Southern Italy compared with the North was 27%. CONCLUSIONS: During the period 1991-2009 Italy experienced a significant decline in IMRs, NMRs and PNMRs. We observed the same pattern for the temporal trends of these indicators across the North, the Center and South of Italy. Despite this decline, geographical disparities persisted.