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INTRODUCTION: Non-pharmacological interventions are increasingly being acknowledged as valuable options to overcome or reduce functional problems in patients with Parkinson's disease. In the last decades, Nordic Walking was employed and investigated by rehabilitation specialists. Clinical trials on the effect of Nordic Walking on motor and non-motor Parkinson's disease symptoms are few, small, and heterogeneous for inclusion criteria and intervention protocols. As a result, Nordic Walking training cannot be recommended as a standard rehabilitative tool in Parkinson's disease patients. METHODS: This randomized controlled single-blind trial recruited Parkinson's disease patients at a Hoehn and Yahr stage between 2 and 3 assigned to a Nordic Walking vs. Walking group. Subjects were extensively assessed for motor and non-motor symptoms at baseline and after 8 weeks of intervention period. To study the effects of intervention on the overall sample, paired-sample t test and Wilcoxon signed rank test were used, while differences between groups were estimated with general linear models repeated-measure and Mann-Whitney U test. RESULTS: Among 32 patients who ended the study period, improvements were observed in the following assessments: global motor outcome (p 0.001), dynamic and static balance ability (p 0.005; p 0.002), global non-motor symptoms outcome (p 0.003), fatigue (p 0.016), anxiety (p 0.043), and quality of life (p 0.003). The treatment group (Nordic Walking) failed to show any difference compared to the control group (Walking) in all considered outcomes. CONCLUSION: Nordic Walking was not superior compared to Walking in the studied population. Moderate intensity outdoor group activities like Nordic Walking and Walking seem to improve motor and non-motor symptoms parameters in patients with Parkinson's disease.

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Tropospheric ozone (O3) produces harmful effects to forests and crops, leading to a reduction of land carbon assimilation that, consequently, influences the land sink and the crop yield production. To assess the potential negative O3 impacts to vegetation, the European Union uses the Accumulated Ozone over Threshold of 40 ppb (AOT40). This index has been chosen for its simplicity and flexibility in handling different ecosystems as well as for its linear relationships with yield or biomass loss. However, AOT40 does not give any information on the physiological O3 uptake into the leaves since it does not include any environmental constraints to O3 uptake through stomata. Therefore, an index based on stomatal O3 uptake (i.e. PODY), which describes the amount of O3 entering into the leaves, would be more appropriate. Specifically, the PODY metric considers the effects of multiple climatic factors, vegetation characteristics and local and phenological inputs rather than the only atmospheric O3 concentration. For this reason, the use of PODY in the O3 risk assessment for vegetation is becoming recommended. We compare different potential O3 risk assessments based on two methodologies (i.e. AOT40 and stomatal O3 uptake) using a framework of mesoscale models that produces hourly meteorological and O3 data at high spatial resolution (12 km) over Europe for the time period 2000-2005. Results indicate a remarkable spatial and temporal inconsistency between the two indices, suggesting that a new definition of European legislative standard is needed in the near future. Besides, our risk assessment based on AOT40 shows a good consistency compared to both in-situ data and other model-based datasets. Conversely, risk assessment based on stomatal O3 uptake shows different spatial patterns compared to other model-based datasets. This strong inconsistency can be likely related to a different vegetation cover and its associated parameterizations.

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The warm-temperate regions of the globe characterized by dry summers and wet winters (Mediterranean climate; MED) are especially vulnerable to climate change. The potential impact on water resources, ecosystems and human livelihood requires a detailed picture of the future changes in this unique climate zone. Here we apply a probabilistic approach to quantitatively address how and why the geographic distribution of MED will change based on the latest-available climate projections for the 21st century. Our analysis provides, for the first time, a robust assessment of significant northward and eastward future expansions of MED over both the Euro-Mediterranean and western North America. Concurrently, we show a significant 21st century replacement of the equatorward MED margins by the arid climate type. Moreover, future winters will become wetter and summers drier in both the old and newly established MED zones. Should these projections be realized, living conditions in some of the most densely populated regions in the world will be seriously jeopardized.

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Mirtazapine is a novel antidepressant with a pharmacologic profile (alpha-2 antagonist, 5HT-(1A) agonist, and 5HT-(2) antagonist) that renders it potentially useful for l-dopa-induced dyskinesias. Drugs with 5HT-(1A) agonistic activity, such as buspirone and tandospirone, have been reported to be effective in reducing l-dopa-induced dyskinesias. Furthermore, 5HT-(2) antagonism may, by reducing substantia nigra pars reticulata hyperactivity, play a role in the improvement of Parkinsonian symptoms and l-dopa-induced dyskinesias, as has been observed with ritanserin, a 5HT-(2) antagonist. Alpha-2 antagonists, such as idazoxan, have recently also been reported to improve l-dopa-induced dyskinesias. The authors investigated the antidyskinetic properties of mirtazapine by designing an open-label study of 20 Parkinsonian patients with l-dopa-induced dyskinesias. Mirtazapine proved to be moderately effective in reducing l-dopa-induced dyskinesias, either alone or in association with amantadine. Mirtazapine may be of use in patients who do not respond or are intolerant to amantadine.

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