Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson's disease: a randomised controlled trial.

OBJECTIVE: To compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson's disease. DESIGN: Prospective, single-blinded, randomised controlled trial. SETTING: Outpatients. PARTICIPANTS: Fifty-one patients with Parkinson's disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. INTERVENTIONS: Both programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. MAIN OUTCOME MEASURES: The Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. RESULTS: The VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference -7.9, 95% CI -13.7 to -2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference -5.2, 95% CI -8.8 to -1.5; P=0.007]. CONCLUSION: These findings suggest that rehabilitation is useful in Parkinson's disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. CLINICAL TRIAL REGISTRATION NUMBER: NCT02807740.

Legionnaires' disease on a cruise ship linked to the water supply system: clinical and public health implications.

The occurrence of legionnaires' disease has been described previously in passengers of cruise ships, but determination of the source has been rare. A 67-year-old, male cigarette smoker with heart disease contracted legionnaires' disease during a cruise in September 1995 and died 9 days after disembarking. Legionella pneumophila serogroup 1 was isolated from the patient's sputum and the ship's water supply. Samples from the air-conditioning system were negative. L. pneumophila serogroup 1 isolates from the water supply matched the patient's isolate, by both monoclonal antibody subtyping and genomic fingerprinting. None of 116 crew members had significant antibody titers to L. pneumophila serogroup 1. One clinically suspected case of legionnaires' disease and one confirmed case were subsequently diagnosed among passengers cruising on the same ship in November 1995 and October 1996, respectively. This is the first documented evidence of the involvement of a water supply system in the transmission of legionella infection on ships. These cases were identified because of the presence of a unique international system of surveillance and collaboration between public health authorities.

Molecular epidemiology of an outbreak of Legionnaires' disease associated with a cooling tower in Genova-Sestri Ponente, Italy.

Fatty acid profile analysis, monoclonal antibody (MAb) subtyping, pulsed-field gel electrophoresis (PFGE), arbitrarily primed polymerase chain reaction (AP-PCR), and ribotyping were used to compare clinical and environmental Legionella pneumophila serogroup 1 isolates from an outbreak of Legionnaires' disease presumptively associated with cooling towers. According to the Oxford subtyping scheme, the MAb subtype of patients' isolates and of two strains originating from a cooling tower was Pontiac, whereas the other isolates were subtype Olda. The strains showed no intrinsic strain-to-strain difference in fatty acid profiles, and ribotyping and length polymorphism of the 16S-23S rDNA intervening regions failed to reveal any differences between the isolates. Conversely, PFGE and AP-PCR appeared to be more discriminatory, as the same genomic profile was found for the clinical and some environmental strains. Meteorologic and epidemiological data and the results of molecular analysis of the Legionella pneumophila serogroup 1 isolates support the hypothesis that the infection was transmitted from one of the cooling towers to the indoor environment of the same building, to homes in proximity that had open windows, and to the streets. In fact, the outbreak diminished and later ended after a part in the tower was replaced. This investigation demonstrates the utility of combined molecular methods (i.e., phenotypic and genomic typing) in comparing epidemiologically linked clinical and environmental isolates. Finally, the outbreak confirms the risk of Legionnaires' disease posed by cooling towers, mainly when atmospheric thermal and humidity inversions occur. This finding emphasizes the need to determine whether the source of infection is in the living or working environment or somewhere else.

[To what extent is breast feeding practiced in Italy today?]. / Quanto è praticato oggi l'allattamento al seno in Italia.

OBJECTIVES: During a survey regarding infant health in 7 regions, diffusion and length of time of breast-feeding nowadays in Italy were studied. MATERIALS AND METHODS: By OMS Epi methodology, 210 children sampled from each area of study and specialized health workers carried out the interviews at home using a specific questionnaire. The mothers were questioned about the length of time they breast fed their child. RESULTS: 76% of mothers said they breastfed, 32% said they did it for less than 3 months and 44% for more. In each area, the percentage of breastfeeding was 70% or more. This percentage changed only if the birth weight was very low or the mothers' instruction was high, but this is probably because the most cultured mothers answered easier they breast fed longer. DISCUSSION: It seems that mothers are pro-breastfeeding and, in each region, just a quarter of them don't practise it. Besides, about half women breastfed for more than 3 months. This study doesn't permit us to know why some women don't breastfeed or why they wean their children too early. For this reason, we need to curry out further studies.

An epidemic of tuberculosis in an elementary school, Sanremo, Italy, 1993.

In late 1992, three cases of tuberculosis were identified in school children attending a small elementary school in Sanremo, Italy. In order to identify further cases and determine the source, an epidemiologic investigation was undertaken. Tine test and X rays were performed on all students and school personnel. A total of 80% of the 59 students in the school had positive tine test reactions, as did 100% of the 12 teachers. All but one of the positive students had converted since last tested, as had the nine teachers who had been previously negative. The source of the outbreak was a teacher who had been in direct classroom contact with two of the five classes and had worked closely with the rest in building of a Christmas creche for the school. This outbreak suggests that increasing attention should be paid to school as potential foci for the spread of tuberculosis and that greater attention be paid to teacher screening, particularly in areas of higher tuberculosis prevalence.