The safety of recreational waters is affected by numerous variables such as the microbiological and chemical quality of water, the number and health conditions of the users, and the correct ...functioning of all technological installations used for water treatment. By evaluating the various health risks related to exposure to swimming pools, spas, and surface waters, this Special Issue seeks to address the proper management of waters used for recreational purposes, both in natural and built environments.
This Issue contains 12 scientific papers. The first four, three of which are literature reviews, illustrate the epidemiological picture of infections related to recreational waters, by describing cases and outbreaks caused by both traditional and emerging microorganisms. The following four papers concern the microbiological monitoring of swimming pools, gardens, estuarine areas, and therapeutic spas. Two of these also analyse the distribution of antibiotic-resistant bacteria and the associated transmission risks. The relationship between microbial indicators and pathogens in recreational water is analysed by the following two papers, one of which is an experimental study on the survival of Salmonella and Escherichia coli in estuarine bank sediments and the other of which is an exhaustive literature review. The last two papers are focused on the development of risk control approaches, including the validation of questionnaire methods to quantify recreational water ingestion and the application of traditional and innovative technologies in water treatment.
Environmental cleaning practice plays an important role in reducing microbial contamination in hospital surfaces and contributes to prevent Healthcare Associated Infections. Adenosine Triphosphate ...(ATP) bioluminescence assay is a commonly used method for assessing environmental cleanliness on healthcare surfaces. This study tested the feasibility of using ATP-bioluminescence assay for evaluating the efficiency of cleaning procedures in the operating theatre settings, comparing the ATP-bioluminescence test with the traditional culture method.
The surfaces of 10 operating rooms of two public hospitals (140 samples in total) were examined "at rest", in two moments of the same daily session: before the first scheduled operation (Pre), and before the second, after a clean environment was re-established (Post). Surface contamination was assessed using the cultural method to detect Total Viable Counts (TVC36°C) and ATP-bioluminescence assay (RLU).
The examined surfaces presented very low TVCs (geometric means: 1.8 CFU/plate; IC95%: 1.6-2.0), always compliant with the relative reference standards. No statistical correlation was found between ATP values and TVCs. However, considering the results in terms of general evaluation of hygienic quality of surfaces, the two methods were consistent in identifying the most contaminated areas (Hospital A > Hospital B; Pre > Post; most contaminated surfaces: scialytic lamp). Furthermore, the ATP mean values showed a progressive increase from surfaces with TVC = 0 to surfaces with TVC > 15 CFU/plate.
Although not an alternative to cultural methods, the ATP-bioluminescence-assay can be a useful tool to measure the efficiency of cleaning procedures also in environments with very low microbial counts. Each health facility should identify appropriate reference values, depending on the devices used and on the basis of the analysis of the data collected through spatial and temporal sampling series. By providing a rapid feedback, the ATP-assay helps to increase the awareness of operators and allows immediate action to be taken in critical situations.
► MBR process is more effective than CASP in the removal of bacteriophages. ► SOMCPH proves to be more resistant to MBR treatment than FRNAPH. ► BFRAGPH are not always detectable in the pre-treated ...effluent. ► SOMCPH are the most suitable indicators to evaluate the MBR process performance. ► SOMCPH are the most suitable indicators to evaluate the safety of the MBR effluent.
The effectiveness of a full scale membrane bioreactor (MBR) in the removal of bacteriophages and bacterial fecal indicators from municipal wastewater was compared with that obtained by conventional activated sludge process (CASP). Somatic coliphages (SOMCPH) and F-RNA specific bacteriophages (FRNAPH) were always detected in the pre-treated effluent (mean: 6Log10), while phages infecting Bacteroides fragilis were not always present (mean: 3.9Log10). The MBR process was able to achieve respectively 2.7 and 1.7Log10 higher reductions of SOMCPH and FRNAPH compared to CASP (significant differences: P<0.05). SOMCPH were found to be the most suitable indicators for assessing MBR performance, since they showed greater resistance to biofiltration than FRNAPH and a more regular distribution in pre-treated effluent than BFRAGPH. Moreover, since the traditional bacterial indicators were almost totally removed by biofiltration, SOMCPH proved to be the best indicators to evaluate the microbiological risk when MBR effluent is discharged into natural waters or reused.
Starting from 2016, a major measles epidemic affected EU/EEA countries, after the measles incidence rate had progressively decreased from 2011 to 2015.
This study describes measles incidences (ECDC ...reports), the vaccination coverages (VCs) (WHO/UNICEF reports) and the vaccination strategies, whether mandatory or recommended (ECDC Vaccine Scheduler), in 30 European countries over the last decade.
VCs were higher in countries with historically mandatory vaccination. However, in these countries, VCs declined between 2010 and 2018, in two cases to levels below 90% at the second dose. Instead, 9 and 12 countries with recommended vaccination increased their VCs, respectively, for the first and the second dose. Overall, the countries with VC ≥ 95% decreased from 20 to 15 for the first dose and from 10 to 7 for the second dose. This trend led Italy, France and Germany to make vaccination mandatory. In Italy this provision was introduced in 2017, and together with the catch-up campaigns on children between 1 and 15 years at school entry, led immediately to a strong effect: the first dose VC passed from 87% in 2016 to 93% in 2018, and from 82% to 89% for the second dose.
Mandatory vaccination is certainly a policy producing positive effects; however, it seems to require additional strategies in order to reach the WHO goal of 95% of VC. Measures such as catch-up action on susceptible populations and communication strategies aimed at increasing awareness and acceptance should be considered.
We investigated Legionella and Pseudomonas contamination of hot water in a cross-sectional multicentric survey in Italy. Chemical parameters (hardness, free chlorine, and trace elements) were ...determined. Legionella spp. were detected in 33 (22.6%) and Pseudomonas spp. in 56 (38.4%) of 146 samples. Some factors associated with Legionella contamination were heater type, tank distance and capacity, water plant age, and mineral content. Pseudomonas presence was influenced by water source, hardness, free chlorine, and temperature. Legionella contamination was associated with a centralized heater, distance from the heater point >10 m, and a water plant >10 years old. Furthermore, zinc levels of <100 microg/L and copper levels of >50 microg/L appeared to be protective against Legionella colonization corrected. Legionella species and serogroups were differently distributed according to heater type, water temperature, and free chlorine, suggesting that Legionella strains may have a different sensibility and resistance to environmental factors and different ecologic niches.
To provide a systematic review of studies that investigated the effects of Active Break (AB) school-based interventions on Physical Activity (PA) levels, classroom behavior, cognitive functions, and ...academic performance in primary school children.
Systematic review and meta-analysis.
Searches of electronic databases and grey literature, with no time restriction and up to April 2019, resulted in 22 intervention studies meeting the inclusion criteria. Quality assessment of the studies was performed in accordance with the Cochrane Tool for Quality Assessment for RCTs and the STROBE tool for observational studies.
Four AB related outcomes were analyzed: (i) AB interventions had a significant effect in increasing PA levels in primary school children, both in terms of increased moderate to vigorous PA and step count. The meta-analysis seems to confirm this trend, showing a statistically significant result for the step count (p<0.00001, CI95% −0.71,1.21) (random model I²=0%). (ii) Regarding classroom behavior, time spent on task (TOT) during lessons significantly increased in each of the included studies. On the other hand, the effects on (iii) cognitive functions (attention components, working memory, executive functions) and (iv) academic achievements (mathematics, reading) were not conclusive.
Positive effects were found for PA levels and classroom behavior, while the conflicting results for cognitive functions and academic achievements suggest that the effect could be more evident with curriculum focused active breaks and active lessons that integrate ABs with key learning aspects and cognitive engagement.
spp. is widespread in many natural and artificial water systems, such as hot water distribution networks, cooling towers, and spas. A particular risk factor has been identified in the use of ...whirlpools and hot tubs in spa facilities and public baths. However, there has been no systematic synthesis of the published literature reporting legionellosis cases or outbreaks related to swimming/spa pools or similar environments used for recreational purposes (hot springs, hot tubs, whirlpools, natural spas). This study presents the results of a systematic review of the literature on cases and outbreaks associated with these environments. Data were extracted from 47 articles, including 42 events (17 sporadic cases and 25 outbreaks) and 1079 cases, 57.5% of which were diagnosed as Pontiac fever, without any deaths, and 42.5% were of Legionnaires' disease, with a fatality rate of 6.3%. The results are presented in relation to the distribution of
species involved in the events, clinical manifestations and diagnosis, predisposing conditions in the patients, favourable environmental factors, and quality of the epidemiological investigation, as well as in relation to the different types of recreational water sources involved. Based on the epidemiological and microbiological criteria, the strength of evidence linking a case/outbreak of legionellosis with a recreational water system was classified as strong, probable, and possible; in more than half of the events the resulting association was strong.
•We describe the management of a family outbreak of scabies.•The possible connection of the outbreak with a nosocomial case is investigated.•The control strategy focused on an information campaign ...and health care staff training.•Control measures were able to prevent outbreak spreading to other communities.•Late recognition of cases and misdiagnosis delayed control measures, increasing costs.
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.
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.
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.
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.
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).
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.
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).
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.
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