Apropriação dos espaços urbanos na infância e na velhice em Brasília (DF) / Occupation of urban spaces in childhood and old age in Brasilia, Brazil / Apropiación de espacios urbanos en la infancia y en la vejez en Brasília, Brasil

Os estudos sobre as relações mútuas entre as pessoas e o ambiente buscam subsidiar melhorias no contexto urbano a partir de métodos e técnicas pautados na compreensão do uso de espaços públicos e privados. A crescente demanda pela promoção de ambientes amigáveis para idosos e crianças nos cenários urbanos direcionou esta pesquisa e elencou dois componentes: o panorama relativo à população local e o arcabouço teórico da psicologia ambiental. Para tanto, buscou-se identificar as principais atividades realizadas por crianças e idosos em seus respectivos locais de moradia. Foram avaliados os principais usos e atividades desses dois grupos, em duas vizinhanças, diferenciando-os de acordo com suas especificidades em termos de demandas individuais e ambientais. As observações sistemáticas a partir da técnica de mapeamento comportamental centrado no lugar (MCCL) ocorreram na cidade de Brasília, Distrito Federal (DF) e permitiram compreender o processo de apropriação dos espaços na infância e na velhice e suas repercussões em termos da congruência pessoa-ambiente. Cada um destes setores organizados a partir de elementos específicos direciona as ações dos participantes para determinados tipos de comportamentos, observados de maneira a compor um roteiro em que a brincadeira (lazer ativo) surge como central na infância e a caminhada (circulação) como mais potente para a população idosa. Os resultados demonstram que o diálogo entre a psicologia ambiental e a ciência do desenvolvimento humano tem sido bastante profícuo e tem contribuído para a compreensão de aspectos da relação pessoa-ambiente em diferentes momentos do ciclo de vida.(AU)

Studies on the mutual relations between people and the environment seek to support improvements in the urban context from methods and techniques based on understanding the use of public and private spaces. The growing demand for the promotion of friendly urban environments for older people and children guided this research, with two notable components: the panorama related to the local population and the theoretical framework of Environmental Psychology. Therefore, we sought to identify the main activities carried out by children and older people in their respective dwellings. The main uses and activities of these two groups were evaluated in two neighborhoods, differentiating them according to their specificities in terms of individual and environmental demands. Systematic observations using the place-centered behavioral mapping technique took place in the city of Brasília, Federal District, and allowed us to understand the process of appropriation of spaces in childhood and old age and its repercussions in terms of person-environment congruence. Each of these sectors, organized from specific elements, directs the participants' actions towards certain types of behavior, observed in order to compose a script in which playing (active leisure) emerges as central in childhood and walking (circulation) as more potent for the older people. The results demonstrated that the dialogue between environmental psychology and the science of human development has been very fruitful and has contributed to the understanding of aspects of the person-environment relationship at different times in the life cycle.(AU)

Los estudios sobre las relaciones mutuas entre las personas y el medio ambiente buscan aportar mejoras en el contexto urbano mediante métodos y técnicas basados en la comprensión del uso de los espacios públicos y privados. La creciente demanda de la promoción de ambientes amigables para las personas mayores y los niños en entornos urbanos guio esta investigación y enumeró dos componentes: el panorama relacionado con la población local y el marco teórico de la Psicología Ambiental. En este contexto, buscamos identificar las principales actividades que realizan los niños y las personas mayores en sus respectivas viviendas. Se evaluaron los principales usos y actividades de estos dos grupos en dos barrios, diferenciándolos según sus especificidades en cuanto a las demandas individuales y ambientales. Las observaciones sistemáticas utilizando la técnica de mapeo conductual centrado en el lugar (MCCL) ocurrieron en la ciudad de Brasília, Distrito Federal (Brasil) y nos permitieron comprender el proceso de apropiación de espacios en la infancia y la vejez y sus repercusiones en la congruencia persona-ambiente. Cada uno de estos sectores, organizados a partir de elementos específicos, orienta las acciones de los participantes hacia determinados comportamientos, observados para componer un guion en el que el juego (ocio activo) emerge como central en la infancia y el caminar (circulación) como el más potente para las personas mayores. Los resultados demuestran que el diálogo entre la Psicología Ambiental y la ciencia del desarrollo humano ha sido muy fructífero y ha contribuido a la comprensión de aspectos de la relación persona-entorno en diferentes momentos del ciclo de vida.(AU)

Making Swimming Pools Safer: Does Copper-Silver Ionization with Chlorine Lower the Toxicity and Disinfection Byproduct Formation?

Swimming pools are commonly treated with chlorine, which reacts with the natural organic matter and organic matter introduced by swimmers and form disinfection byproducts (DBPs) that are associated with respiratory-related issues, including asthma, in avid swimmers. We investigated a complementary disinfectant to chlorine, copper-silver ionization (CSI), with the aim of lowering the amount of chlorine used in pools and limiting health risks from DBPs. We sampled an indoor and outdoor pool treated with CSI-chlorine during the swimming season in 2017-2018 and measured 71 DBPs, speciated total organic halogen, in vitro mammalian cell cytotoxicity, and N-acetyl-l-cysteine (NAC) thiol reactivity as a cytotoxicity predictor. Controlled, simulated swimming pools were also investigated. Emerging DBP concentrations decreased by as much as 80% and cytotoxicity decreased as much as 70% in the indoor pool when a lower chlorine residual (1.0 mg/L) and CSI was used. Some DBPs were quantified for the first time in pools, including chloroacetaldehyde (up to 10.6 µg/L), the most cytotoxic haloacetaldehyde studied to date and a major driver of the measured cytotoxicity in this study. Three highly toxic iodinated haloacetic acids (iodoacetic acid, bromoiodoacetic acid, and chloroiodoacetic acid) were also quantified in pools for the first time. We also found that the NAC thiol reactivity was significantly correlated to cytotoxicity, which could be useful for predicting the cytotoxicity of swimming pool waters in future studies.

Aspectos relacionados à segurança em um serviço de hidroterapia / Aspects relating to safety in a hydrotherapy service

Objetivo: Observar e relatar aspectos relacionados à segurança em um serviço de hidroterapia do município de Goiânia, Goiás. Casuística e Métodos: Trata-se de um estudo observacional realizado entre agosto e dezembro de 2017, no período matutino, em um serviço de Fisioterapia de Goiânia, Goiás. Primeiramente, realizou-se uma revisão da literatura buscando artigos científicos no Google Acadêmico, Scielo, PubMed, Medline e literatura especializada (normas técnicas, portarias e resoluções). O levantamento abrangeu a literatura nacional e internacional, artigos originais gratuitos e disponíveis na íntegra, sendo utilizados como descritores: acessibilidade, padrões da hidroterapia, risco, contraindicações, perigo e precauções. Em seguida, tomando como referência as normas e recomendações para serviços de hidroterapia encontradas na literatura, foi construída uma tabela constando os aspectos de segurança observados. Resultados: De 31 itens elencados e observados neste estudo, quatro (12,9%) não puderam ser avaliados, 14 (45,2%) atenderam aos padrões e recomendações e 13 (41,9%) apresentaram necessidade de reflexão e melhoria, uma vez que não atenderam às exigências apresentadas nas normas vigentes. Conclusão: O serviço de hidroterapia observado requer a adoção de algumas medidas de segurança, recomendando-se um olhar mais cuidadoso frente ao assunto e um esforço coletivo no sentido de ampliar a discussão sobre segurança nesta área, a fim de tornar os profissionais conscientes de seus atos e do pleno atendimento às normas técnicas vigentes

Objective: Observe and report safety-related aspects in a hydrotherapy service in the city of Goiânia, Goiás. Casuistry and Methods: This is an observational study carried out between August and December of 2017, in the morning period, in a Physiotherapy service in the city of Goiânia, Goiás. Initially, a literature review was carried out searching for scientific articles on Google Scholar, Scielo, PubMed, Medline and specialized literature (technical standards, ordinances and resolutions). The survey covered national and international literature, original articles were free and available in full, being used as descriptors: accessibility, hydrotherapy standards, risk, contraindications, danger and precautions. Then, with the rules/recommendations for a hydrotherapy service taken from the literature review, a table was built and during the internship, the safety aspects contained in the table were observed by that service. Results: Of 31 items listed and observed in this study, four (12.9%) could not be evaluated, 14 (45.2%) met the standards and recommendations and 13 (41.9%) generated energy for reflection and improvement, since they did not meet the requirements of current regulations. Conclusion: The observed hydrotherapy service requires the adoption of some safety measures, recommending a more careful look at the subject and a collective effort to expand the discussion on safety in this area, in order to make professionals aware of their acts and full compliance with current technical standards.

Legionellosis incidents associated with spa pools, England, 2002-2018.

BACKGROUND: Spa pools (SPs) pose risks of Legionella infection for users and bystanders. METHODS: We searched the National Enhanced Legionella Surveillance System for reported SP-associated legionellosis incidents in England between 2002 and 2018 involving at least two cases. RESULTS: For seven legionellosis SP-associated incidents, six were in commercial settings such as hotels. The median number of cases per outbreak was four (range 2-115). CONCLUSION: SP-associated legionellosis incidents were mainly located in commercial settings with a wider range of cases than those recognised in previous publications, reinforcing the need for effective environmental controls for SPs in a range of settings.

Influence of hydrotherapy pool water recirculation regime on Staphylococcus species concentration at subsurface: Preliminary experimental data from a pilot.

Pools are prone to contamination from microbial pathogens from human external microbiota, including mainly Staphylococcus species. These bacteria originate mainly from the skin and rhinopharynx and tend to concentrate at the surface/subsurface. Being protected by films derived from mucus and sebum, they are markedly resistant to biocides. Our study aimed to evaluate the respective impact of mixed and reverse hydraulicity techniques on the concentration of Staphylococcus species at the subsurface following bathing by four individuals in an experimental pool. Disinfection, filtration and water renewal of the pool were stopped in order to study only the influence of the water recirculation regime. We found a significant reduction of 31.7% (Test 1), 50.9% (Test 2) and 41.9% (Test 3) in total Staphylococcus species counts at the subsurface when using reverse versus mixed hydraulicity. However, this reduction is not a pollution cut but a pollution shift, resulting from an increase in the outlet water flow rate by overflow channel from 49.3 to 100%. This experimental model was far removed from real life conditions and associated with a series of limitations. However, it seems that the type of water recirculation regime is a critical factor in the bacterial quality of pool water. These preliminary findings need to be confirmed in additional studies using more realistic conditions.

Efeito da fisioterapia aquática na força muscular respiratória de crianças e adolescentes com Síndrome de Down / Effect of aquatic physioterapy on the respiratory muscle strength of children and teenagers with Down Syndrome

A força muscular respiratória em crianças e adolescentes com Síndrome de Down é comprometida pela hipotonia generalizada que os acometem. Analisar os efeitos da fisioterapia aquática na força muscular respiratória em crianças e adolescentes com síndrome de Down. Estudo de intervenção, quasi-experimental, com amostra constituída de oito crianças e adolescentes diagnosticados com SD e média de idade de 12 anos (± 3,8). Foram realizadas 10 sessões de fisioterapia aquática, com 50 minutos de duração cada, em piscina com água aquecida. A força muscular respiratória foi avaliada a partir da pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) com auxílio do manuvacuômetro, sendo obtido seus valores antes do primeiro atendimento e após o último. Analisou-se ainda a saturação periférica de oxigênio e frequência cardíaca. Para comparação das médias antes e depois da intervenção foi utilizado o Teste T pareado. Amostra de indivíduos predominantemente do sexo feminino (75,0%), pardos (75,0%) e residentes em zona urbana (87,5%). A comparação da PImáx e PEmáx antes e após as 10 sessões de fisioterapia aquática evidenciou melhora da força muscular inspiratória e expiratória, sendo tais diferenças estatisticamente significantes (valor de p<0,01). Também foram notadas melhorias na frequência cardíaca e saturação de oxigênio (valor de p<0,05) com a intervenção. Destaca-se neste estudo que a fisioterapia aquática parece ser um recurso terapêutico eficiente para o fortalecimento da musculatura respiratória e melhora dos sinais vitais de crianças e adolescentes de com diagnóstico de Síndrome de Down.

Respiratory muscle strength in children and adolescents with Down syndrome is compromised by the generalized hypotonia that affects them. This study aims to analyze the effects of aquatic physical therapy on respiratory muscle strength in children and adolescents with Down syndrome. Material and method: A quasi-experimental study with a sample consisting of eight children and adolescents diagnosed with DS and mean age of 12 years (± 3.8). Ten sessions of aquatic physiotherapy were performed, each with a duration of 50 minutes, in a pool with heated water. Respiratory muscle strength was assessed from maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) using a manuvacuometer, and its values were obtained before the first session and after the last one. Peripheral oxygen saturation and heart rate were also analyzed. The paired T-test was used to compare the means before and after the intervention. Sample of predominantly female (75.0%), brown (75.0%) and urban residents (87.5%). The comparison of MIP and MEP before and after the 10 sessions of aquatic physiotherapy showed an improvement in inspiratory and expiratory muscle strength, and these differences were statistically significant (p <0.01). Improvements in heart rate and oxygen saturation (p value <0.05) were also noted with the intervention. In this study, aquatic physiotherapy seems to be an efficient therapeutic resource for the strengthening of respiratory muscles and improvement of the vital signs of children and adolescents diagnosed with Down's Syndrome.

Acanthamoeba in Southeast Asia – Overview and Challenges

Acanthamoeba, one of free-living amoebae (FLA), remains a high risk of direct contact with this protozoan parasite which is ubiquitous in nature and man-made environment. This pathogenic FLA can cause sight-threatening amoebic keratitis (AK) and fatal granulomatous amoebic encephalitis (GAE) though these cases may not commonly be reported in our clinical settings. Acanthamoeba has been detected from different environmental sources namely; soil, water, hot-spring, swimming pool, air-conditioner, or contact lens storage cases. The identification of Acanthamoeba is based on morphological appearance and molecular techniques using PCR and DNA sequencing for clinico-epidemiological purposes. Recent treatments have long been ineffective against Acanthamoeba cyst, novel anti-Acanthamoeba agents have therefore been extensively investigated. There are efforts to utilize synthetic chemicals, lead compounds from medicinal plant extracts, and animal products to combat Acanthamoeba infection. Applied nanotechnology, an advanced technology, has shown to enhance the anti-Acanthamoeba activity in the encapsulated nanoparticles leading to new therapeutic options. This review attempts to provide an overview of the available data and studies on the occurrence of pathogenic Acanthamoeba among the Association of Southeast Asian Nations (ASEAN) members with the aim of identifying some potential contributing factors such as distribution, demographic profile of the patients, possible source of the parasite, mode of transmission and treatment. Further, this review attempts to provide future direction for prevention and control of the Acanthamoeba infection.

Occurrence of Antibiotic-Resistant Bacteria in Therapy Pools and Surrounding Surfaces.

The number of patients colonized with antibiotic-resistant bacteria is increasing in health care facilities. Because transmission of antibiotic-resistant bacteria is feared, there exist reports that the affected patients are frequently excluded from hydrotherapy, which is a non-invasive and beneficial treatment used for patients with different diseases. Data from the literature suggest that deficient water disinfection measures exist, which are not always sufficient to kill all released bacteria. If the pool water is not disinfected properly, it may also infect the bathers. Immunocompromised patients are particularly susceptible to be infected with (antibiotic-resistant) bacteria. In order to determine the distribution of antibiotic-resistant bacteria in the pool water treatment system and the pool environment and to estimate the associated transmission risk we analyzed samples from eleven health care facilities. Antibiotic-resistant bacteria were found in the water and surface samples collected. One hundred and two antibiotic-resistant isolates from water samples and 307 isolates from surrounding surfaces were obtained, respectively. The majority of the isolates belonged to non-fermenting Gram-negative rods, like Pseudomonas spp. Some isolates were resistant to a wide range of the tested antibiotics. The results indicate a relation between the number of isolates in water samples and the number of patients using the pools in combination with deficiencies in water treatment. In the pool environment the highest number of isolates was obtained from barefoot areas and floor cleaning equipment.

Legionellosis Associated with Recreational Waters: A Systematic Review of Cases and Outbreaks in Swimming Pools, Spa Pools, and Similar Environments.

Legionella 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 Legionella 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.

Formation of trihalomethanes as disinfection byproducts in herbal spa pools.

Herbal spa treatments are favorite recreational activities throughout the world. The water in spas is often disinfected to control pathogenic microorganisms and guarantee hygiene. However, chlorinated water may cause the formation of disinfection byproducts (DBPs). Although there have been many studies on DBP formation in swimming pools, the role of organic matter derived from herbal medicines applied in herbal spa water has been largely neglected. Accordingly, the present study investigated the effect of herbal medicines on the formation of trihalomethanes (THMs) in simulated herbal spa water. Water samples were collected from a spa pool, and then, disinfection and herbal addition experiments were performed in a laboratory. The results showed that the organic molecules introduced by the herbal medicines are significant precursors to the formation of THMs in spa pool water. Since at least 50% of THMs were produced within the first six hours of the reaction time, the presence of herbal medicines in spa water could present a parallel route for THM exposure. Therefore, despite the undeniable benefits of herbal spas, the effect of applied herbs on DBP formation in chlorinated water should be considered to improve the water quality and health benefits of spa facilities.

Test of precoat filtration technology for treatment of swimming pool water.

The technical performance of a precoat filter was compared with that of a traditional sand filter. Particle concentration and size distribution were measured before and after the filtration of swimming pool water. Both the sand and precoat filters could reduce the particle concentration in the effluent. However, higher particle removal efficiency was generally observed for the precoat filter, especially for particles smaller than 10 µm in diameter. Adding flocculant improved the removal efficiency of the sand filter, resulting in removal efficiencies comparable to those of the precoat filter. Three powders, i.e., two types of perlite (Harbolite® and Aquatec perlite) and cellulose fibers (Arbocel®), were tested for the precoat filter, but no significant difference in particle removal efficiency was observed among them. The maximum efficiency was reached within 30-40 min of filtration. The energy required for the pumps increased by approximately 35% over a period of 14 days. The energy consumption could be reduced by replacing the powder on the filter cloth. The sand filter was backwashed once a week, while the powder on the precoat filter was replaced every two weeks. Under these conditions, it was possible to reduce the water used for cleaning by 88% if the precoat filter was used instead of the sand filter.

Monitoring and factors affecting levels of airborne and water bromoform in chlorinated seawater swimming pools.

Water and air quality of eight seawater swimming pools using chlorine disinfection was measured during four sampling campaigns, spread on one full-year, and in four thalassotherapy centers located in Southeast of France. Concentrations of trihalomethanes (THMs) in air and in water as well as concentrations of parameters, including nonpurgeable organic carbon (NPOC), free residual chlorine (Clf), pH, Kjeldhal Nitrogen (KN), salinity, conductivity, bromide ions and, water and air temperature, were measured. Water and air samples were collected in triplicates morning - at the opening of the pools -, noon and night - at the closing of the pools -, in summer and winter. Data analysis was performed by Principal Component Analysis (PCA) and rotated component matrix, from both data quality and other parameters such as TOC, aromaticity (UV254), pH, hygrometry, and free residual chlorine (Clf). This statistical analysis demonstrates a high correlation between TOC, Clf and UV254 and THM levels found in air and water, particularly for the major ones (CHBr3 in water: 300.0µg/L mean, 1029.0µg/L maximum; CHBr3 in air: 266.1µg/m3 mean, 1600.0µg/m3 maximum, and CHClBr2 in water: 18.9µg/L mean, 81.0µg/L maximum; CHClBr2 in air: 13.6µg/m3 mean, 150.0µg/m3 maximum). These high levels of bromoform (CHBr3) are particularly worrisome in such health institutions, even these levels do not exceed the Permissible Exposure Limit (PEL) of 5mg/m3 as an 8hour time-weighted average currently fixed by various administrations, such as Occupational Safety and Health Administration (OSHA).

Removals of cryptosporidium parvum oocysts and cryptosporidium-sized polystyrene microspheres from swimming pool water by diatomaceous earth filtration and perlite-sand filtration.

Removal of Cryptosporidium-sized microspheres and Cryptosporidium parvum oocysts from swimming pools was investigated using diatomaceous earth (DE) precoat filtration and perlite-sand filtration. In pilot-scale experiments, microsphere removals of up to 2 log were obtained with 0.7 kg·DE/m2 at a filtration rate of 5 m/h. A slightly higher microsphere removal (2.3 log) was obtained for these DE-precoated filters when the filtration rate was 3.6 m/h. Additionally, pilot-scale perlite-sand filters achieved greater than 2 log removal when at least 0.37 kg/m2 of perlite was used compared to 0.1-0.4 log removal without perlite both at a surface loading rate of 37 m/h. Full-scale testing achieved 2.7 log of microspheres and oocysts removal when 0.7 kg·DE/m2 was used at 3.6 m/h. Removals were significantly decreased by a 15-minute interruption of the flow (without any mechanical agitation) to the DE filter in pilot-scale studies, which was not observed in full-scale filters. Microsphere removals were 2.7 log by perlite-sand filtration in a full-scale swimming pool filter operated at 34 m/h with 0.5 kg/m2 of perlite. The results demonstrate that either a DE precoat filter or a perlite-sand filter can improve the efficiency of removal of microspheres and oocysts from swimming pools over a standard sand filter under the conditions studied.

Occurrence of brominated disinfection byproducts in the air and water of chlorinated seawater swimming pools.

An undesirable consequence of disinfection is the formation of chemical contaminants known as disinfection byproducts (DBPs). Chronic exposure to DBPs has been linked to adverse health effects. The occurrence of DBPs in chlorinated pools filled with seawater (such as thalassotherapy pools and pools in spas) has received little attention so far. The present study evaluated the speciation and levels of disinfection byproducts in indoor swimming pools filled with seawater and treated with chlorine. Water and air samples were collected from three indoor swimming pools located in Southern France. Several classes of DBPs including trihalomethanes, haloacetic acids, haloacetonitriles, and trihaloacetaldehydes were analyzed in water. Halogenated volatile organic compounds were analyzed in air. Extractable organic halides (EOX) contents were determined using combustion/micro-coulometry system. The speciation of DBPs identified in the three pools was predominantly brominated. The mean (arithmetic) concentration of bromoform, dibromoacetic acid, tribromoacetic acid, dibromoacetonitrile and bromal hydrate in the three pools was 79.2, 72.9, 59.9, 26.9 and 10.0µg/L, respectively. By weight, HAAs represented the most abundant chemical class followed by THMs. In air, bromoform was the most abundant THM occurring at a mean concentration of 133.2µg/m3 in the three pools. The mean EOX level was 706µgCl-/L for the three pools. In average, the quantified DBPs accounted for only 14% of EOX, thus 86% of EOX remained unknown. Further research is warranted to identify the unknown DBPs.

Effect of Underwater Exercise on Lower-Extremity Function and Quality of Life in Post-Stroke Patients: A Pilot Controlled Clinical Trial.

OBJECTIVES: To date, controlled clinical trials evaluating the efficacy of underwater exercise in improving the lower-extremity function and quality of life (QOL) in post-stroke patients have yet to be conducted. The purpose of the present study was to determine whether repeated underwater exercise enhances the therapeutic effect of conventional therapy for post-stroke patients. DESIGN: This was a pilot controlled clinical trial. SETTING: The study took place in a research facility attached to a rehabilitation hospital. PATIENTS: This prospective trial included 120 consecutive post-stroke inpatients with hemiplegic lower limbs (Brunnstrom stage 3-6). Patients were assigned to either an experimental or a control group. Patients in the experimental group received both repeated underwater exercise and conventional rehabilitation therapy. INTERVENTIONS: The underwater exercise consisted of 30-min training sessions in a pool with a water temperature of 30-31°C in which patients followed the directions and movements of trained staff. Training sessions were conducted once a day on 2 days of the week for a total of 24 times. Patients in the control group received only the conventional therapy. OUTCOME MEASURES: The 10-Minute Walk Test (10MWT), the Modified Ashworth Scale, and the 36-Item Short Form Health Survey were the outcome measures used. Lower-extremity function and QOL were assessed before and upon completion of the 12-week program. RESULTS: Improvements in 10MWT results and spasticity parameters were greater in the experimental group than they were in the control group (p < 0.01). Significant differences between the groups were observed in magnitudes of changes of all QOL parameters (p < 0.01). CONCLUSIONS: Combining conventional therapy with repeated underwater exercise may improve both lower-extremity function and QOL in post-stroke patients.

Reliability of ground reaction forces in the aquatic environment.

The aim of this study was to verify the reliability of the kinetic parameters of gait using an underwater force platform. A total of 49 healthy participants with a median age of 21years were included. The kinetic gait data were collected using a 0.6×0.6×0.1m aquatic force plate (Bertec®), set in a pool (15×13×1.30m) with a water depth of 1.20m and water temperature of 32.5°C. Participants walked 10m before reaching the platform, which was fixed to the ground. Participants were instructed to step onto the platform with their preferred limb and data from three valid attempts were used to calculate the average values. A 48-h interval between tests was used for the test-retest reliability. Data were analyzed using interclass correlation coefficients (ICC) and results demonstrated that reliability ranged from poor to excellent, with ICC scores of between 0.24 and 0.87 and mean differences between (d¯)=-0.01 and 0.002. The highest reliability values were found for the vertical (Fz) and the lowest for the mediolateral components (Fy). In conclusion, the force platform is reliable for assessing the vertical and anteroposterior components of power production rates in water, however, caution should be applied when using this instrument to evaluate the mediolateral component in this environment.

[Irritant contact dermatitis caused by direct contact with oleander (Nerium oleander)]. / Dermatite irritative par contact direct avec du laurier rose (Nerium oleander).

BACKGROUND: Although the oleander plant is practically ubiquitous throughout the Mediterranean area, very few publications refer to its cutaneous toxicity. PATIENTS AND METHODS: Herein, we report two cases of irritant contact dermatitis caused by oleander. The patients in question were twins who had oleander leaves applied directly to their face for 20minutes. The initial lesions consisted of periorbital erythema, followed by the emergence of papules and macules. Vesicles and crusts appeared over the ensuing 24hours. Treatment included withdrawal of the toxic agent, prescription of oral antihistamines, and the topical application of dermocorticoids to the lesions for two weeks. The outcome on the 9th day was slightly hypochromic and atrophic. Complete restitutio ad integrum of the skin was observed after 30 days. DISCUSSION: In our patients, a joint effect of ultraviolet radiation (phytophotodermatitis) and chlorine from the swimming pool cannot be ruled out. Although the substances present in oleanders (irritant saponins and glycosides) can cause chemical irritant dermatitis, immunological reactions cannot be excluded. The lack of signs of systemic toxicity observed is the result of the factors governing transdermal diffusion of the toxic glycosides found in oleander. CONCLUSION: These two cases provide a timely reminder, both for the general public and for healthcare professionals, of the potential biohazards of oleander, not only because of its systemic toxicity but also because of the risks associated with cutaneous exposure.

Effectiveness of aquatic exercise for treatment of knee osteoarthritis: Systematic review and meta-analysis.

OBJECTIVE: This paper presents a systematic review and meta-analysis of the effectiveness of aquatic exercise for treatment of knee osteoarthritis (OA). METHODS: PubMed, the Cochrane Library, Embase, CAMbase, and the Web of Science were screened through to June 2014. Only randomized controlled trials (RCTs) comparing aquatic exercise with control conditions were included. Two authors independently selected trials for inclusion, assessed the included trials, and extracted data. Outcome measures included pain, physical function, joint stiffness, quality of life (QOL), and safety. Pooled outcomes were analyzed using standardized mean difference (SMD). RESULTS: There is a lack of high quality studies in this area. Six RCTs (398 participants) were included. There was moderate evidence for a moderate effect on physical function in favor of aquatic exercise immediately after the intervention, but no evidence for pain or QOL when comparing aquatic exercise with nonexercise. Only one trial reported 3 months of follow-up measurements, which demonstrated limited evidence for pain improvement with aquatic exercise and no evidence for QOL or physical function when comparing aquatic exercise with nonexercise. There was limited evidence for pain improvement with land-based exercise and no evidence for QOL or physical function, when comparing aquatic exercise with land-based exercise according to follow-up measurements. No evidence was found for pain, physical function, stiffness, QOL, or mental health with aquatic exercise immediately after the intervention when comparing aquatic exercise with land-based exercise. Two studies reported aquatic exercise was not associated with serious adverse events. CONCLUSION: Aquatic exercise appears to have considerable short-term benefits compared with land-based exercise and nonexercise in patients with knee OA. Based on these results, aquatic exercise is effective and safe and can be considered as an adjuvant treatment for patients with knee OA. Studies in this area are still too scarce and too short-term to provide further recommendations on how to apply this therapy.

Swimming facilities and work-related asthma.

BACKGROUND: Exposure to chlorinated water in swimming facilities may aggravate preexisting asthma or cause new onset asthma. This may be a particular problem for individuals who work and therefore spend prolonged time at swimming facilities. Chloramines formed by the interaction of chlorine-based disinfection products with the nitrogen in water from human sweat, urine and skin cells are the suspected causal agents. METHODS: Cases were reviewed from the state surveillance systems in California (CA), Michigan (MI) and New Jersey (NJ) to identify individuals with confirmed work-related asthma (WRA) attributed to exposures in swimming pools, water parks or hydrotherapy spas. A standardized method was used to confirm cases. RESULTS: A total of 44 confirmed cases of WRA were identified; 17 from 1994 to 2011 in CA, 15 from 1991 to 2012 in MI and 12 from 1990 to 2011 in NJ. A majority (52.2%) of the cases were new onset; 31.8% secondary to an acute exposure incident and 20.4% to repeated exposure. These represented 0.3-1.6% of all confirmed cases of WRA received during these time periods. Maintenance workers (34.9%) and lifeguards (31.8%) were the most common occupations. CONCLUSIONS: Swimming pool workers were identified from three states where the pool environment was either a trigger of preexisting asthma or associated with new onset of WRA. Regulations to require air monitoring and improvements in ventilation are recommended to reduce exposure levels of chloramines, the presumed etiologic agents. Clinical assessment of patients with asthma should include consideration of the effect on respiratory symptoms from exposures in a swimming pool environment.