Health Resort Medicine, Balneology, Medical Hydrology and Climatology are not fully recognised as independent medical specialties at a global international level. Analysing the reasons, we can ...identify both external (from outside the field) and internal (from inside the field) factors. External arguments include, e.g. the lack of scientific evidence, the fact that Balneotherapy and Climatotherapy is not used in all countries, and the fact that Health Resort Medicine, Balneology, Medical Hydrology and Climatology focus only on single methods and do not have a comprehensive concept. Implicit barriers are the lack of international accepted terms in the field, the restriction of being allowed to practice the activities only in specific settings, and the trend to use Balneotherapy mainly for wellness concepts. Especially the implicit barriers should be subject to intense discussions among scientists and specialists. This paper suggests one option to tackle the problem of implicit barriers by making a proposal for a structure and description of the medical field, and to provide some commonly acceptable descriptions of content and terminology. The medical area can be defined as “medicine in health resorts” (or “health resort medicine”). Health resort medicine includes “all medical activities originated and derived in health resorts based on scientific evidence aiming at health promotion, prevention, therapy and rehabilitation”. Core elements of health resort interventions in health resorts are balneotherapy, hydrotherapy, and climatotherapy. Health resort medicine can be used for health promotion, prevention, treatment, and rehabilitation. The use of natural mineral waters, gases and peloids in many countries is called balneotherapy, but other (equivalent) terms exist. Substances used for balneotherapy are medical mineral waters, medical peloids, and natural gases (bathing, drinking, inhalation, etc.). The use of plain water (tap water) for therapy is called hydrotherapy, and the use of climatic factors for therapy is called climatotherapy. Reflecting the effects of health resort medicine, it is important to take other environmental factors into account. These can be classified within the framework of the ICF (International Classification of Functioning, Disability and Health). Examples include receiving health care by specialised doctors, being well educated (ICF-domain: e355), having an environment supporting social contacts (family, peer groups) (cf. ICF-domains: d740, d760), facilities for recreation, cultural activities, leisure and sports (cf. ICF-domain: d920), access to a health-promoting atmosphere and an environment close to nature (cf. ICF-domain: e210). The scientific field dealing with health resort medicine is called health resort sciences. It includes the medical sciences, psychology, social sciences, technical sciences, chemistry, physics, geography, jurisprudence, etc. Finally, this paper proposes a systematic international discussion of descriptions in the field of Health Resort Medicine, Balneology, Medical Hydrology and Climatology, and discusses short descriptive terms with the goal of achieving internationally accepted distinct terms. This task should be done via a structured consensus process and is of major importance for the publication of scientific results as well as for systematic reviews and meta-analyses.
Psorijaza je kronična, upalna, imunosno posredovana bolest kože i drugih organskih sustava, koja zahvaća 2-3 % cjelokupne svjetske populacije i predstavlja značajan javnozdravstveni problem. Poželjno ...je da suvremena terapija psorijaze ima dugoročnu učinkovitost i dobar sigurnosni profil, a danas obuhvaća upotrebu lokalne i sustavne terapije, kao i fototerapije i fotokemoterapije. Fototerapija se provodi izlaganjem sunčevoj svjetlosti te ultraljubičastom A i B zračenju, dok konvencionalna fotokemoterapija podrazumijeva zajedničku upotrebu ultraljubičastog zračenja i fotosenzibilizirajućeg lijeka. Oba su se oblika terapije pokazala iznimno učinkovitima, posebice pri njihovoj kombiniranoj primjeni s određenim lokalnim ili sustavnim lijekovima. U današnje vrijeme je, također, sve više zastupljen holistički pristup liječenju psorijaze poput balneofototerapije, zahvaljujući kojoj su brojne zemlje postale poznata odredišta lječilišnog turizma.
Psoriasis is a chronic, inflammatory, immune-mediated disease of the skin and other organ systems, which affects 2-3 % of the entire world population and represents a significant public health problem. It is desirable that modern psoriasis therapy has long-term efficacy and a good safety profile, and today includes the use of local and systemic therapy, as well as phototherapy and photochemotherapy. Phototherapy is carried out by exposure to sunlight and ultraviolet A and B radiation, while conventional photochemotherapy involves using of ultraviolet radiation and a photosensitizing drug. Both forms of therapy have proven to be highly effective, especially when combined with certain local or systemic medications. Nowadays, a holistic approach to treating psoriasis, such as balneophototherapy, is also increasingly common, thanks to which numerous countries have become well-known health resort destinations.
This paper presents a review of the worldwide applications of geothermal energy for direct utilization and updates the previous survey carried out in 2015. We also compare data from WGC1995, WGC2000, ...WGC2005, WGC2010, and WGC2015 presented at World Geothermal Congresses in Italy, Japan, Turkey, Indonesia and Australia. As in previous reports, an effort is made to quantify geothermal (ground-source) heat pump data. The present report is based on country update papers received from 62 countries and regions reporting on their direct utilization of geothermal energy. Twenty-six additional countries were added to the list based on other sources of information. Thus, direct utilization of geothermal energy in a total of 88 countries is an increase from 82 in 2015, 78 reported in 2010, 72 reported in 2005, 58 reported in 2000, and 28 reported in 1995. An estimation of the installed thermal power for direct utilization at the end of 2019 is used in this paper and equals 107,727 MWt, a 52.0 % increase over the 2015 data, growing at a compound rate of 8.73 % annually. The thermal energy used is 1,020,887 TJ/yr (283,580 GW h/yr.), a 72.3 % increase over 2015, growing at a compound rate of 11.5 % annually. The distribution of thermal energy used by category is approximately 58.8 % for geothermal (ground-source) heat pumps, 18.0 % for bathing and swimming (including balneology), 16.0 % for space heating (of which 91.0 % is for district heating), 3.5 % for greenhouse heating, 1.6 % for industrial applications, 1.3 % for aquaculture pond and raceway heating, 0.4 % for agricultural drying, 0.2 % for snow melting and cooling, and 0.2 % for other applications. Energy savings amounts to 596 million barrels (81.0 million tonnes) of equivalent oil annually, preventing 78.1 million tonnes of carbon and 252.6 million tonnes of CO2 from being released to the atmosphere. This includes savings for geothermal heat pumps in the cooling mode, compared to using fuel oil to generate electricity. Since it is almost impossible to separate direct-use from electric power generation for the following, they are combined: approximately 2647 wells were drilled in 42 countries, 34,500 person-years of effort were allocated in 59 countries, and US $22.262 billion invested in projects by 53 countries.
The COVID-19 pandemic has dramatically affected spa and balneology not only in the Czech Republic. Generally, almost two years without spa patients and clients led to a dramatic outflow of labor. The ...article main purpose is to analyze pandemic impact on the structure of spa patients and clients, to identify main current spa problems to be overcome, and to summarize possible future trends in modern spa and balneology for current and future spa clients. Spa will remain an important medical solution for treatment of some diagnoses using healing mineral-medical waters and natural sources, but they must innovate their services and treating programs to answer current questions and clients 'demands. It will be a complex patient care combining body and mental treatment and care with the use of so-called therapeutic landscape, a unique landscape surrounding spa towns and places, as well as wellness aspects. Modern spa must be an integral part of health care systems in Europe.
This systematic review is aimed to evaluate the effects of balneotherapy with thermal mineral water for managing the symptoms and signs of osteoarthritis located at any anatomical site. The ...systematic review was conducted according to the PRISMA Statement. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane Library, DOAJ and PEDro. We included clinical trials evaluating the effects of balneotherapy as a treatment for patients with osteoarthritis, published in English and Italian language, led on human subjects. The protocol was registered in PROSPERO. Overall, 17 studies have been included in the review. All of these studies were performed on adults or elderly patients suffering from osteoarthritis localized to knees, hips, hands or lumbar spine. The treatment assessed was always the balneotherapy with thermal mineral water. The outcomes evaluated were pain, palpation/pressure sensibility, articular tenderness, functional ability, quality of life, mobility, deambulation, ability to climb stairs, medical objective and patients’ subjective evaluation, superoxide dismutase enzyme activity, serum levels of interleukin-2 receptors. The results of all the included studies agree and demonstrated an improvement of all the symptoms and signs investigated. In particular, pain and quality of life were the main symptoms evaluated and both improved after the treatment with thermal water in all the studies included in the review. These effects can be attributed to physical and chemical-physical properties of thermal mineral water used. However, the quality of many studies resulted not so high due and, consequently, it is necessary to perform new clinical trial in this field using more correct methods for conducting the study and for processing statistical data.
•This paper presents a review of the worldwide applications of geothermal energy for direct utilization, and update the previous survey carried out in 2010.•This report is based on country update ...papers and other sources from 82 countries.•The installed thermal power for direct utilization at the end of 2014 was 70,885MWt.•The thermal energy used is 592,638TJ/year (164,635GWh/year).•The largest use of thermal energy is approximately 55.2% for geothermal heat pumps.
This paper presents a review of the worldwide applications of geothermal energy for direct utilization, and updates the previous survey carried out in 2010. We also compare data from 1995, 2000 and 2005 presented at World Geothermal Congresses in Italy, Japan and Turkey, respectively (WGC95, WGC2000, and WGC2005). As in previous reports, an effort is made to quantify ground-source (geothermal) heat pump data. The present report is based on country update papers received from 70 countries and regions of which 65 reported some direct utilization of geothermal energy. Seventeen additional countries were added to the list based on other sources of information. Thus, direct utilization of geothermal energy in a total of 82 countries is an increase from the 78 reported in 2010, 72 reported in 2005, 58 reported in 2000, and 28 reported in 1995. An estimation of the installed thermal power for direct utilization at the end of 2014 is used in this paper and equals 70,885MWt, 46.2% increase over the 2010 data, growing at a compound rate of 7.9% annually with a capacity factor of 0.265. The thermal energy used is 592,638TJ/year (164,635GWh/year), about a 39.8% increase over 2010, growing at a compound rate of 6.9% annually. The distribution of thermal energy used by category is approximately 55.2% for ground-source heat pumps, 20.2% for bathing and swimming (including balneology), 15.0% for space heating (of which 89% is for district heating), 4.9% for greenhouses and open ground heating, 2.0% for aquaculture pond and raceway heating, 1.8% for industrial process heating, 0.4% for snow melting and cooling, 0.3% for agricultural drying, and 0.2% for other uses. Energy savings amounted to 352 million barrels (52.8 million tonnes) of equivalent oil annually, preventing 46.1 million tonnes of carbon and 149.1 million tonnes of CO2 being released to the atmosphere, this includes savings for geothermal heat pumps in the cooling mode (compared to using fuel oil to generate electricity). Since it was almost impossible to separate direct-use from electric power generation for the following, they are combined:approximately 2218 well were drilled in 42 countries, 34,000 person-years of effort were allocated in 52 countries, and US $20 billion invested in projects by 49 countries.
This study aims to estimate geothermal potential, radioactivity levels, and environmental pollution of six most popular spas in Central Serbia (Ovčar, Gornja Trepča, Vrnjačka, Mataruška, Bogutovačka ...and Sokobanja), as well as to evaluate potential exposure and health risks for living and visiting population. Thermal possibilities of the studied spas showed medium and low geothermal potential with total thermal power of 0.025 MW. Gamma dose rates in air varied from 63 to 178 nSv h−1. Specific activities of natural radionuclides (226Ra, 232Th and 40K) and 137Cs in soil were measured; annual effective doses and excess lifetime cancer risk from radionuclides were calculated. Radon concentration in thermal-mineral waters from the spas ranged between 1.5 and 60.7 Bq L−1 (the highest values were measured in Sokobanja). The annual effective dose from radon due to water ingestion was calculated. The analyzed soils had a clay loam texture. The presence of As, Cr, Cu, Fe, Mn, Ni, Pb, Cd, Zn, and Hg in soil was investigated. The concentrations of As, Cr, Ni, and Hg exceeded the regulatory limits in many samples. Soil samples from Mataruška spa were generally the most contaminated with heavy metals, while the lowest heavy metal concentrations were observed in Sokobanja. Health effects of exposure to heavy metals in soil were estimated by non-carcinogenic risk and carcinogenic risk assessment. Total carcinogenic risk ranged between 6 × 10−4 and 137 × 10−4 for children and between 0.1 × 10−4 and 2.2 × 10−4 for adults. The sum of 16 PAHs analyzed in soil samples varied from 92 to 854 μg kg−1.
•Medium or low thermal potential of spas with total power of 0.025 MW was estimated.•High radon concentration from Sokobanja water samples was detected.•As, Cr, Ni and Hg in soil exceeded the regulatory limits.•More than a third of soil samples were contaminated with PAHs.
Bleach baths have been proposed as a treatment for decreasing the severity of atopic dermatitis (AD). However, conflicting results have been found regarding their efficacy.
To determine the efficacy ...of bleach vs water baths at decreasing AD severity.
We performed a systematic review of all studies evaluating the efficacy of bleach baths for AD. Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus were searched. Two authors independently performed study selection and data extraction.
Five studies were included in the review. Four studies reported significantly decreased AD severity in patients treated with bleach on at least 1 time point. However, of 4 studies comparing bleach with water baths, only 2 found significantly greater decreases in AD severity with bleach baths, 1 found greater decreases with water baths, and 1 found no significant differences. In pooled analyses, there were no significant differences observed between bleach vs water baths at 4 weeks vs baseline for the Eczema Area and Severity Index (I
= 98%; random effect regression model, P = .16) or body surface area (I
= 96%; P = .36).
Although bleach baths are effective in decreasing AD severity, they do not appear to be more effective than water baths alone. Future larger-scale, well-designed randomized controlled trials are needed.
For a long time, balneotherapy and health resort treatment was considered the privilege of the well-to-do. In Russia, recreational areas developed much later than in Europe. Their development was ...directly related to restoring the health of the military, the more so since these areas, with few exceptions, were located near the outskirts of the country and the location of large military contingents. The outbreak of the First World War aggravated the lack of capacities of domestic health-resorts. The state expanded the benefits to private and cooperative capital for the development of old resorts and the establishment of new ones. Because of the prolonged delay typical for the tsarist bureaucracy, the work on the development of the domestic health resorts began only in 1916. The war showed the importance of health resorts for preserving the army's combat efficiency and, in some cases, prevented the implementation of these projects due to concern of the local authorities and people towards an increase in the number of outsiders in the formerly sparsely populated areas. After the revolution, the Soviet social support agencies were involved in the distribution of spa vouchers to cash-strapped workers. In the northern provinces, the meager budgets received state funding for the establishment of health resorts on the mined-out salt fields. The local councils of the South set up health resorts in nationalized private dachas. Health resorts of the Black Sea coast and Kavminvod have never stopped their work. They functioned as boarding houses for retired military personnel. After the Civil War, every effort was made to attract leisure travelers to the country's resorts. Voucher-holders and «savage» travelers had privileges in food provision. Later, the resort areas were assigned to the first supply category. Despite eight years of military operations on the Russian territory during these years, there were conditions for a sharp growth of mass health resort recreation. This article reviews a large number of original sources and is intended to show, using historical examples, the state importance of health resorts as a means of medical rehabilitation. Paradoxically, it is under difficult political and economic circumstances that health resort recreation has become available for the general population.
Balneotherapy for chronic venous insufficiency de Moraes Silva, Melissa Andreia; Nakano, Luis Cu; Cisneros, Lígia L ...
Cochrane database of systematic reviews,
08/2019, Letnik:
8
Journal Article
Recenzirano
Odprti dostop
Chronic venous insufficiency (CVI) is a progressive and common disease that affects the superficial and deep venous systems of the lower limbs. CVI is characterised by valvular incompetence, reflux, ...venous obstruction, or a combination of these with consequent distal venous hypertension. Clinical manifestations of CVI include oedema, pain, skin changes, ulcerations and dilated skin veins in the lower limbs. It can result in a large financial burden on health systems. There is a wide variety of treatment options or therapies for CVI, ranging from surgery and medication to compression and physiotherapy. Balneotherapy (treatments involving water) is a relatively cheap option and potentially efficient way to deliver physical therapy for people with CVI.
To assess the efficacy and safety of balneotherapy for the treatment of people with chronic venous insufficiency (CVI).
The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED and CINAHL databases, the World Health Organization International Clinical Trials Registry Platform and the Clinical Trials.gov trials register to August 2018. We searched the LILACS and IBECS databases. We also checked references, searched citations and contacted study authors to identify additional studies.
We included randomised and quasi-randomised controlled trials comparing balneotherapy with no treatment or other types of treatment for CVI. We also included studies that used a combination of treatments.
Two review authors independently reviewed studies retrieved by the search strategies. Both review authors independently assessed selected studies for complete analysis. We resolved conflicts through discussion. We attempted to contact trial authors for missing data, obtaining additional information. For binary outcomes (leg ulcer incidence and adverse events), we presented the results using odds ratio (OR) with 95% confidence intervals (CI). For continuous outcomes (disease severity, health-related quality of life (HRQoL), pain, oedema, skin pigmentation), we presented the results as a mean difference (MD) with 95% CI.
We included seven randomised controlled trials with 891 participants (outpatients in secondary care). We found no quasi-randomised controlled trials. Six studies (836 participants) evaluated balneotherapy versus no treatment. One study evaluated balneotherapy versus a phlebotonic drug (melilotus officinalis) (55 participants). There was a lack of blinding of participants and investigators, imprecision and inconsistency, which downgraded the certainty of the evidence.For the balneotherapy versus no treatment comparison, there probably was no improvement in favour of balneotherapy in disease severity signs and symptom score as assessed using the Venous Clinical Severity Score (VCSS) (MD -1.66, 95% CI -4.14 to 0.83; 2 studies, 484 participants; moderate-certainty evidence). Balneotherapy probably resulted in a moderate improvement in HRQoL as assessed by the Chronic Venous Insufficiency Questionnaire 2 (CVIQ2) at three months (MD -9.38, 95% CI -18.18 to -0.57; 2 studies, 149 participants; moderate-certainty evidence), nine months (MD -10.46, 95% CI -11.81 to -9.11; 1 study; 55 participants; moderate-certainty evidence), and 12 months (MD -4.99, 95% CI -9.19 to -0.78; 2 studies, 455 participants; moderate-certainty evidence). There was no clear difference in HRQoL between balneotherapy and no treatment at six months (MD -1.64, 95% CI -9.18 to 5.89; 2 studies, 445 participants; moderate-certainty evidence). Balneotherapy probably slightly improved pain compared with no treatment (MD -1.23, 95% CI -1.33 to -1.13; 1 study; 390 participants; moderate-certainty evidence). There was no clear effect related to oedema between the two groups at 24 days (MD 43.28 mL, 95% CI -102.74 to 189.30; 2 studies, 153 participants; very-low certainty evidence). There probably was no improvement in favour of balneotherapy in the incidence of leg ulcers (OR 1.69, 95% CI 0.82 to 3.48; 2 studies, 449 participants; moderate-certainty evidence). There was probably a reduction in incidence of skin pigmentation changes in favour of balneotherapy at 12 months (pigmentation index: MD -3.59, 95% CI -4.02 to -3.16; 1 study; 59 participants; low-certainty evidence). The main complications reported included erysipelas (OR 2.58, 95% CI 0.65 to 10.22; 2 studies, 519 participants; moderate-certainty evidence), thromboembolic events (OR 0.35, 95% CI 0.09 to 1.42; 3 studies, 584 participants; moderate-certainty evidence) and palpitations (OR 0.33, 95% CI 0.01 to 8.52; 1 study; 59 participants; low-certainty evidence), with no clear evidence of an increase in reported adverse effects with balneotherapy. There were no serious adverse events reported in any of the studies.For the balneotherapy versus a phlebotonic drug (melilotus officinalis) comparison, we observed no clear difference in pain symptoms (OR 0.29, 95% CI 0.03 to 2.87; 1 study; 35 participants; very low-certainty evidence) and oedema (OR 0.21, 95% CI 0.02 to 2.27; 1 study; 35 participants; very low-certainty evidence). This single study did not report on the other outcomes of interest.
We identified moderate- to low-certainty evidence that suggests that balneotherapy may result in a moderate improvement in pain, quality of life and skin pigmentation changes and has no clear effect on disease severity signs and symptoms score, adverse effects, leg ulcers and oedema when compared with no treatment. For future studies, measurements of outcomes such as disease severity sign and symptom score, quality of life, pain and oedema and choice of time points during follow-up must be standardised for adequate comparison between trials.
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