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INTRODUCTION Bone fractures are the main consequences of osteoporosis as representing a serious obstacle to aging in good health and compromising independence, quality of life and lifespan. Patients with a vertebral fracture should be considered for anti-fracture therapy including physical activity [Kendler, 2016]. The aim of this study was to measure the efficacy of our APA protocol in terms of quality of life, fear of falling and physical fitness and, in particular, to evaluate if the adherence had an effect on these outcomes. METHODS The APA group performed 1 hour twice a week for 6 months exercise protocol, specific for osteoporosis, while the Control Group (CG) received the generic indication on the importance of physical activity. The outcomes assessed at the baseline and at the end of the study were: quality of life (ECOS-16), fear of falling (FES-1), functional exercise capacity (6MWT), balance and gait (Tinetti Scale), flexibility of the column (Chair Sit & Reach). Effect sizes (EF) were calculated using Cohen’s d. To assess the potential impact of adherence, we divided the APA group according to the adherence percentage: 75% versus >75%, to evaluate if there is an effect on the main outcomes. RESULTS All patients who completed the study and participated in more than 50% of lessons were included in the analyses (40 women): 22 of the APA group and 18 of the CG. The adherence calculated as number of sessions performed compared to the sessions proposed was 75.8% (from 56.4% to 97.8%). According to Cohens’ d, a "big" effect (>0.8) of the intervention was observed for 6 outcomes (ECOS-16, ES: 1.204; FES-I, ES: 1.007; 6MWT, ES: 1.390; Tinetti Scale, ES: 0.871; Balance, ES: 0.969; Chair Sit & Reach Left, ES: 1.000) and a "medium" effect (>0.5) for 4 outcomes (VAS, ES: 0.510; Borg Scale, ES: 0.654; Gait, ES: 0.639; Chair Sit & Reach Right, ES: 0.739). The number of sessions attended by APA group did not have a significant impact on the results, but slightly influenced the effect size of some items such as: Tinetti Scale (ES: 0.903), Gait (ES: 0.889) and Balance (ES: 0.863). CONCLUSION The big effect sizes suggest that our APA protocol have clinical significance in addition to being statistically significant. There is no significant dependence demonstrated by Cohen's d between improvement in tests and adherence. Therefore, the improvement can be also achieved in those who do not reach the cut-off of 75%, but who nevertheless attended at least 50%. REFERENCES Kendler DL et al, Vertebral Fractures: Clinical Importance and Management. Am J Med 2016,129(2):221.e1-10. doi: 10.1016/j.amjmed.2015.09.020.

Background: Pedometers are inexpensive and valid tools for monitoring physical activity. This study aimed to validate pedometers as an alternative option to Arab Teens Lifestyle (ATLS) questionnaire for evaluating physical activity in Saudi Arabia young women. Methods: Ninety-nine female students, aged 19-23, were recruited at a female University in Riyadh, in Saudi Arabia. Participants wore HJ-203 OMRON pedometer for 7 consecutive days and at the end, they completed the part of ATLS questionnaire related to physical activity. Results: Step count was significantly associated with total time spent on all physical activities (r=0.284; p=0.027) and time spent on high-intensity physical activities (r=0.308; p=0.006) but not with time spent on moderate-intensity physical activities (r=0.184; p=0.145). Step count showed a significant association with time spent in walking (r=0.289; p=0.008), one of the most frequent activities. Mean step count, low in both groups, was significantly higher in the group of active students compared to the inactive (6447±2426 vs 5035±2426; p=0.029). Conclusion: This study encourages the use of pedometers instead of questionnaires to evaluate physical activity. Pedometers can also be a useful tool to promote physical activity in a population of Arab young female students, where walking is the most usual form of exercising.

Le acque termali sono particolari acque minerali naturali caratterizzate da una peculiare composizione salina, utilizzate a fini terapeutici. Negli ultimi anni il termalismo ha cambiato in parte la propria collocazione nel sistema produttivo, poiché gli stabilimenti termali, accanto alle tradizionali applicazioni curative, hanno dato impulso alla creazione di centri benessere, trasformandosi sempre più in strutture turistico-ricreative e in luoghi frequentati da una pluralità di persone con esigenze e stato di salute diversi. Dopo aver esaminato le caratteristiche terapeutiche delle acque termali, gli autori si soffermano sul potenziale rischio di infezione associato alla loro esposizione, legato principalmente a contaminazione da parte di microrganismi di origine acquatica potenzialmente patogeni che possono trovare nei sistemi di distribuzione idrica degli stabilimenti termali le condizioni per moltiplicarsi e colonizzare l’impianto. Sono esaminati i principali agenti infettivi che, secondo le evidenze scientifiche, possono provocare casi sporadici o focolai epidemici associati all’esposizione ad acqua termale, in particolare Legionella pneumophila, Pseudomonas aeruginosa, micobatteri e amebe a vita libera. Sono inoltre prese in considerazione le modalità di controllo della contaminazione microbica, tenendo in considerazione le linee guida e le normative esistenti ed esaminando le modalità di applicazione del sistema di valutazione e gestione del rischio basato sui principi del sistema HACCP (Autocontrollo).

Dopo un inquadramento generale degli aspetti epidemiologici dell'osteoporosi, si analizzano i benifici che l'attività fisica esercita aul paziente osteoporotico ed il ruolo nella prevenzione primaria, secondaria e terziaria, secondo le evidenze scientifiche. Sono in seguito esaminati i Programmi di AFA (Attività Fisica Adattata) proposti per ila riabilitazione funzionale nell’osteoporosi.

Background Osteoporosis is a major health burden worldwide and require a multi-modal approach including exercise. Fractures have a substantial impact on quality of life (QoL) so exercise programs may to be conducted by trainers able to deal with this condition, because exercise alone, even if in the right dosage, seems to be not enough to improve QoL. A quasi-experimental pilot study performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol specifically designed for osteoporotic women with vertebral fractures and its effect on QoL, with a specific focus on trainer's role. Methods The Experimental Group (EG) performed APA protocol 1hour twice a week for 6 months, while the Control Group (CG) received standard care. QoL was assessed at baseline and follow-up with ECOS-16 questionnaire and semi structured interviews to understand women perceptions regarding trainer's role. Using mixed-methods quantitative and qualitative data were analyzed using SPSS 5 and NVivo 12, respectively. Results 40 post-menopausal women (mean age: 67.6±4.6) divided in 2 groups EG = 22 and CG = 18, completed the study. At follow-up, EG improved significantly QoL (EG: -0.5±0.5 vs CG: 0.0±0.3 p = 0.02). The APA intervention had a significant effect on all the components of QoL, as measured by the disease-specific ECOS-16 questionnaire: Physical Component Summary (PCS) (EG: -0.4±0.5 vs CG: 0.0±0.4 p = 0.06) and Mental Component Summary (MCS) (EG: -0.5±0.6 vs CG: 0.1±0.5 p = 0.02). The interviews confirmed this result, emphasizing the key role of the trainer in improving their QoL. The adherence calculated as number of sessions performed compared to the sessions proposed was 75.8%. No injuries were observed. Conclusions The feasibility, the safety, and the positive effect of the proposed exercise protocol on QoL confirmed also by the interviews, show that principles of exercise education applied by trainers should be extended also to patients with other chronic condition. Key messages Trainers specifically educated, could be a means of achieving the goal improving people’s QoL, as they occupy the role of exercise experts and also an educational, relational and support role. The management of osteoporosis is multi-modal and includes exercise, often recommended as a beneficial non-pharmacological treatment to slow the rate of bone loss and improve quality of life.

The study aimed to assess the prevalence of Legionella spp. in dental unit waterlines of a dental clinic and to verify whether the microbiological parameters used as indicators of water quality were correlated with Legionella contamination. A risk management plan was subsequently implemented in the dental health care setting, in order to verify whether the adopted disinfection protocols were effective in preventing Legionella colonization. The water delivered from syringes and turbines of 63 dental units operating in a dental clinic, was monitored for counts of the heterotrophic bacteria P. aeruginosa and Legionella spp. (22 degrees C and 37 degrees C). At baseline, output water from dental units continuously treated with disinfection products was more compliant with the recommended standards than untreated and periodically treated water. However, continuous disinfection was still not able to prevent contamination by Legionella and P. aeruginosa. Legionella was isolated from 36.4%, 24.3% and 53.3% of samples from untreated, periodically and continuously treated waterlines, respectively. The standard microbiological parameters used as indicators of water quality proved to be unreliable as predictors of the presence of Legionella, whose source was identified as the tap water used to supply the dental units. The adoption of control measures, including the use of deionized water in supplying the dental unit waterlines and the application of a combined protocol of continuous and periodic disinfection, with different active products for the different devices, resulted in good control of Legionella contamination. The efficacy of the measures adopted was mainly linked to the strict adherence to the planned protocols, which placed particular stress on staff training and ongoing environmental monitoring.

The microbiological contamination of operating theatres and the lack of adherence to best practices by surgical staff represent some of the factors affecting Surgical Site Infections (SSIs). The aim of the present study was to assess the microbiological quality of operating settings and the staff compliance to the SSI evidence-based control measures. Ten operating rooms were examined for microbiological contamination of air and surfaces, after cleaning procedures, in “at rest” conditions. Furthermore, 10 surgical operations were monitored to assess staff compliance to the recommended practices. None of the air samples exceeded microbiological reference standards and only six of the 200 surface samples (3.0%) were slightly above recommended levels. Potentially pathogenic bacteria and moulds were never detected. Staff compliance to best practices varied depending on the type of behaviour investigated and the role of the operator. The major not compliant behaviours were: pre-operative skin antisepsis, crowding of the operating room and hand hygiene of the anaesthetist. The good environmental microbiological quality observed is indicative of the efficacy of the cleaning-sanitization procedures adopted. The major critical point was staff compliance to recommended practices. Awareness campaigns are therefore necessary, aimed at improving the organisation of work so as to facilitate compliance to operative protocols.

Background:A large proportion of children do not reach the recommended levels of physical activity for health. A quasiexperimental study with nonrandom assignment was performed to evaluate the effectiveness and feasibility of a school-based physical education intervention aimed at increasing the levels of moderate-to-vigorous physical activity (MVPA).Methods:Ten classes from 4 primary schools, including 241 children aged 8 to 10 years, were recruited. The experimental group (n = 97) received 4 additional sessions/week of 60 minutes of MVPA for 8 months. The control group (n = 135) continued their standard program (2 sessions of 50 minutes/week). Motor abilities (standing long jump, handgrip strength, Harre circuit, sit and reach), physical fitness (Yo-Yo Intermittent Recovery Level-1), anthropometric measures (body mass index, waist to height ratio), and self-efficacy (Perceived Physical Ability Scale for Children) were evaluated at baseline and after the intervention.Results:The experimental group significantly improved in the Harre circuit both in males (P < .001) and females (P < .01), whereas physical fitness test improved only in males (P < .001). Males in the experimental group improved the perception of self-efficacy in coordinative abilities (P = .017).Conclusions:The proposed school-based MVPA program showed effectiveness and feasibility. The differences observed by gender highlight the need to use different strategies to increase the involvement of all the participants.