Exploring the potential role of health resort medicine in the management of breast cancer-related lymphedema: a viable alternative for innovative rehabilitation opportunities?

Lymphedema is a chronic and progressive disorder of the lymphatic system that impairs the return of lymphatic fluid. Breast cancer treatment can cause breast cancer-related lymphedema (BCRL), with axillary lymph node dissection and regional lymph node radiation being established risk factors. BCRL can cause severe morbidity, disability, and reduced quality of life. Early detection and treatment are essential to prevent the disease from progressing and causing complications. According to the International Society of Lymphology, complex decongestive therapy (CDT) is the most effective conservative treatment for lymphedema. Aquatic exercise is a safe and effective form of therapeutic CDT exercise that can improve joint range of motion, reduce pain, and positively impact limb volume. Additionally, health resort medicine and thermal mineral-rich waters may provide synergistic benefits for therapeutic exercise programs. Therefore, we believe that consideration should be given to whether the spa setting could represent a viable alternative for the rehabilitation of BCRL patients.

[Assessment of reserves of mineral water's geothermal sources in the south of Tyumen region]. / Otsenka zapasov geotermal'nykh istochnikov mineral'nykh vod yuga Tyumenskoi oblasti.

There are rich reserves of underground mineral waters in the south of Tyumen region, which are generally deep located, in the so-called difficult exchange water zone (on average at a depth of 1311.29±34.53 m). Currently, there is a lack of assessment of prognostic resources of underground mineral waters in the south of Tyumen region. The article provides an assessment of underground mineral (therapeutic) waters' reserves (2011-2019 yrs.) in the considered territory. It was shown that the number of deposits, their sites and underground mineral waters' well bores is 76, of which less than half are in operation, as at date of 01.07.2021. Moreover, the number of deposits is remained almost constant since 2011 yr. Meanwhile, underground mineral (therapeutic) waters' reserves are gradually decreasing. Thus, there is a necessity to intensify not only the stocktaking and identification of mineral waters' well bores, but also to develop the new medical technologies to use geothermal waters in rehabilitation and prevention. Monitoring for underground waters' condition should be continued with the use of modern research tools and techniques. The above mentioned will give a new impetus to the development of health resort sphere in the tourism industry, in addition to increasing the therapeutic effects of mineral waters.

[The role of health resort factors in preconception preparation of patients with reproductive disorders]. / Rol' sanatorno-kurortnykh faktorov v pregravidarnoi podgotovke patsientok s narusheniyami reproduktivnoi funktsii.

Reproductive dysfunction is a multifactorial problem, for the correction of which the most difficult are cases of pathology comorbidity. Individual preconception preparation, taking into account risk factors, is recognized as an effective measure to increase the chances of conception and prevent reproductive losses. OBJECTIVE: Optimization of treatment and rehabilitation measures at the preconception stage in patients with reproductive disorders. MATERIAL AND METHODS: The effectiveness of the use of natural and preformed physical factors in the preconception preparation of 180 women who underwent medical and rehabilitation measures in the health resort of the Altai Territory - the resort town of Belokurikha (Group 1, 79 patients) and outpatient conditions in the city of Barnaul (Group 2, 101 patients). Comprehensive spa treatment included climatotherapy, a combination of various methods: balneotherapy, peloidtherapy, physiotherapy and a prolonged course of herbal medicine. RESULTS: In patients of the 1st group, who underwent a course of rehabilitation treatment in a sanatorium-resort environment, compared with patients of the 2nd group, early reproductive losses were less common during pregnancy (7.1% and 20.7%, respectively; p=0.04) and more frequent term deliveries occurred (92.8% and 77.2%, respectively; p=0.02). The most significant predictors of the ineffectiveness of preconception preparation were the presence in patients of: chronic cystitis and autoimmune thyroiditis with hypothyroidism; oligomenorrhea at the time of pregnancy planning; aggravated by early reproductive losses and long-term wearing of intrauterine contraception history; burdened heredity for violation of carbohydrate metabolism. CONCLUSION: Comprehensive preconception preparation in the sanatorium-resort conditions of Belokurikha helps to increase the fertility of patients with reproductive disorders, the trophostimulating effect in the genital organs and the restoration of endometrial reception, which makes it possible to recommend this method for use in clinical practice.

[Climate-therapy at seaside resorts in modern medical and wellness practice]. / Klimatolechenie na primorskikh kurortakh v sovremennoi meditsinskoi i ozdorovitel'noi praktike.

A scientific review is devoted to the study of the coastal climate in the resort treatment role of patients with chronic diseases and its impact on the health and life quality of the population of the seacoasts. The sources were the Cochrane Library, PubMed MEDLINE, MedlinePlus, PedRO, Google Scholar, British Medical Journal, Elsevier, The Global Wellness Institute, eLIBRARY.ru. The review includes 40 publications including 22 domestic and 18 foreign ones on clinical and surrogate outcomes of climate-therapy at seaside resorts in the structure of spa treatment in patients with chronic diseases. The health problems among the population of the seacoasts are considered. The features of conducting evidence-based studies in assessing the effects of climate procedures are noted. The analysis of the therapeutic and health-improving effect results of the seaside climate and the associated forms of thalassotherapy - terrenkur, swimming, aqua gymnastics, sea bathing, heliotherapy, landscape therapy, and the use of maricultureis carried out. The article presents statistically reliable data on the favorable outcomes of treatment of chronic forms of musculoskeletal, skin, pulmonary and cardiac pathology under the influence of thalassotherapy methods. It was found that the effectiveness of climate-therapy in oncological practice, the treatment of pollinosis, the use of algae and other maricultures has been insufficiently proven: the possibility of percutaneous permeability to seawater and its components. The risk of developing negative meteorological reactions during climate-therapy was noted.

[300 years of the first Russian resort. History of studies of Marcial Waters]. / Pervomu russkomu kurortu - 300 let. Istoriia izucheniia martsial'nykh vod.

The article presents the main stages of studying the mineral ferruginous waters of the first Russian spa 'Marcial Waters', the beginning of the 300-year history of which is associated with the name of Peter I. It gives the results of studies of natural sources in the 18th and 19th centuries. Studies of the mineral waters during the exploration and exploitation of the field in the 20th century have shown that in the local area, wells open confined groundwater that has various mineralization and iron content and forms the characteristic hydrochemical type of mineral water called marcial. It is noted that the results of the long-term, but insufficiently regular and analytically comprehensive series of observations of the composition of an extremely unstable system of ferruginous waters do not allow one to unequivocally identify seasonal and long-term changes in the composition of the water. Regular isotope-chemical studies, which began in 2018, will make it possible to identify the patterns of formation of unique fresh high-iron waters.

OCCUPATIONAL EXPOSURE ASSESSMENT AT A THERAPEUTIC RADON SPA FACILITY IN HUNGARY.

In order to estimate occupational exposure of workers in a therapeutic radon spa facility, radon concentration in the workplace air was investigated at Markhot Ferenc Hospital, Eger, Hungary. The investigated balneotherapeutic facility and its natural hot spa water are used for treatments and rehabilitations of rheumatic patients. Radon concentration, radon decay products at a bathhouse, treatment rooms and a consultation room were continuously measured in August and September 2018. In the present study, different levels of radon concentration among the observation sites and its clear temporal variations were found, though radon concentrations in the investigated sites were below 300 Bq m-3. Regarding such radon fluctuation and low equilibrium factor level (0.1), the annual effective doses of workers are estimated to be around 0.5 mSv year-1.

Impact of radon and combinatory radon/carbon dioxide spa on pain and hypertension: Results from the explorative RAD-ON01 study.

OBJECTIVES: Therapies with low doses of radon have beneficial effects on patients suffering from chronic painful degenerative and inflammatory diseases. We already showed that this is accompanied by systemic immune modulations. We here focus on pain-reducing effects of very low doses of radon by adding carbon dioxide water and its impact on heart rate variability (HRV), blood pressure and free radicals. METHODS: 97 of 103 patients receiving radon spa (1.200 Bq/l at 34 °C or 600 Bq/l, 1 g/l CO2 at 34 °C) were monitored before and at three different time points after therapy. Individual pain perception was analyzed and the capability to process radicals. At each time point, the hypertensive patients (n = 46) were examined over 24 h for blood pressure and HRV. RESULTS: Long-term pain reduction was observed in the majority of patients. A modulation of superoxide dismutase was identified, presumably representing a priming effect for lowering radiation stress. Further, lowering of blood pressure, especially in those patients who additionally received carbon dioxide, was seen. Radon did in particular impact on HRV implying lasting relaxation effects. CONCLUSION: Radon/carbon dioxide spa efficiently reduces pain. In particular, patients simultaneously suffering from painful and cardiovascular diseases should be treated by combination of radon and CO2.

[Carboxytherapy - an innovative trend in resort medicine]. / Karboksiterapiia - odno iz innovatsionnykh napravlenii v kurortologii.

Carboxytherapy (the treatment based on carbon dioxide injections) is a multipurpose and widely used medical technology. The use of CO2 injections (intracutaneous, subcutaneous, and pneumopuncture) have substantially supplemented and increased the practical relevance of carboxytherapy as a method for the treatment of many diseases. Thanks to it physiological properties, CO2 has antihypoxic, antioxidant, vasodilatory, anti-inflammatory, analgesic, and spasmolytic activities; moreover, it improves blood viscosity, stimulates neoangiogenesis, and regenerative processes. Carbon dioxide is a sort of biochemical 'peacemaker' in tissue oxygenation: when blood cells are exposed to high CO2 concentrations (Bohr effect), the rate of gas exchange (CO2 and O2) increases. The human organism interprets carboxytherapy (local hypercapnia) as oxygen deficiency and responses to it by boosting not only the blood flow, but also the vascular endothelial growth factor which stimulates neoangiogenesis and in the long run improves blood supply and tissue trophism. The multiple mechanisms of action, polymodal efficacy, a tool kit with a wide range of detectors and various modes of treatment make carboxytherapy a popular medical technology all over the world, namely in cosmetology, dermatology, aesthetic medicine, angiology, orthopaedics, cardiology, neurology, pulmonology, gynaecology, urology, proctology, plastic and general surgery, and other areas. Carboxytherapy provides a perfect example of the off-label usage in medicine that made it one of the most extensively applied medical technology for the treatment of various diseases despite the lack of the preclinical data and scarce relevant information available in textbooks, reference books and booklets.

Hydrogeochemical and biomedical insights into germanium potential of curative waters: a case study of health resorts in the Sudetes Mountains (Poland).

Germanium is considered to be a non-essential element; however, little is still known about its significance for living organisms. It exerts prophylactic and therapeutic effects in the treatment of serious diseases such as cancer, HIV infection, and others. Germanium does not exhibit acute toxicity, but, as it tends to accumulate in various organs and tissues, undesirable and even dangerous side effects have been reported after prolonged and/or high dosage application. In general, inorganic compounds of germanium are more toxic than its organic compounds. Further studies should be performed to elucidate the exact molecular mechanism of germanium action, to determine the safe and effective dose of germanium via curative/mineral waters, and to understand the applications and benefits of using germanium-enriched waters in balneotherapy. The geochemistry of curative (cold CO2-rich, thermal) waters from spas in the Sudetes (Poland) was clarified in terms of components and mineral phases which might govern germanium. Germanium and silicon in thermal (above 20 °C) waters presumably result from the solubility of silicates in crystalline (granites, gneisses) aquifer rocks and might be controlled by neo-formed quartz. The cold CO2-rich waters revealed a significant diversity of aqueous chemistry and relationships of germanium with iron, silicon, or arsenic. Locally, both in sedimentary (sandstones) and metamorphic (gneisses) aquifer rocks, primary (silicates) and/or secondary (oxides) iron-containing minerals likely release germanium into solution. In the CO2-rich waters of the western part of the Klodzko Region, germanium distinctly correlates with arsenic. It is hypothesized that both elements are co-sourced from crystalline basement and/or migration of substances of post-magmatic origin along deep-seated dislocations related to the seismically active Porící-Hronov fault zone. This area was proposed as the most prospective one for finding waters rich in germanium in the Sudetes.

Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients.

The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis (p = 0.063) and rheumatoid arthritis (p = 0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis (p = 0.068), rheumatoid arthritis (p = 0.111), and rotator cuff tendinitis (p = 0.078) subgroups. In daily clinical practice, spa therapy is prescribed and practiced mainly for osteoarthritis, then fibromyalgia, lumbar/cervical disc herniation, and nonspecific low back pain; and less for ankylosing spondylitis, rheumatoid arthritis, and rotator cuff tendinitis. The study results suggest that real-life spa therapy may be effective in a variety of rheumatic and musculoskeletal diseases by improving pain and function.

[The spa and health resort- based treatment of back pain syndrome in the adolescents presenting with juvenile idiopathic scoliosis]. / Sanatorno-kurortnoe lechenie bolevogo sindroma v spine u podrostkov s yunosheskim idiopaticheskim skoliozom.

The relevance of the problem arises from the lack of substantiation for the inclusion of transcutaneous spinal direct current stimulation (tSDCS) in the comprehensive spa and health resort-based treatment of back pain syndrome in the adolescents presenting with juvenile idiopathic scoliosis. AIM: The objective of the present study was to demonstrate the effectiveness of transcutaneous spinal direct current stimulation for the comprehensive spa and health resort-based treatment of back pain syndrome in the adolescents presenting with juvenile idiopathic scoliosis. MATERIAL AND METHODS: A total of 18 patients with scoliosis forming the study group 1 received the traditional comprehensive spa and health resort-based treatment. The course of transcutaneous spinal direct current stimulation was prescribed to 38 other patients (comprising group 2) in addition to the standard procedures. Another control group was comprised of 15 practically healthy adolescents having no signs of spinal deformations. The visual analog scale for pain, the McGill questionnaire, the scale for the assessment of the situational and personal uneasiness levels (Spilberger Ch.D., Khanin Yu.L.), and the Beck and Tsung depression scales were used, beside the routine clinical methods. Statistical data processing was carried out with the use of the Statistica 6.0 software package. RESULTS: In the group of patients treated with the use of transcutaneous spinal direct current stimulation, regression of pain syndrome was well apparent. In the boys with the severity of pain estimated at 2 points based on the visual analog scale who received the standard course of the spa and health resort-based treatment, the pain rank index and the index of the number of the selected descriptors decreased significantly but nonetheless remained higher than in the patients treated by means of tSDCS as a component of the combined therapy (p=0.039). Simultaneously, the significantly lower level of situational (Q1=25.00; Me=36.50; Q3=45.00; p=0.036) and personal (Q1=26.00; Me=36.50; Q3=44.00; p=0.07) anxiety was observed in the group of girls in comparison with the group of those given only the standard course of the spa and health resort-based treatment. In addition, the level of trait anxiety in the female patients treated with the use of tSDCS was lower than in the girls of the control group (Q1=46.00; Me=49.00; Q3=51.5; p=0.001). In the boys undergoing the course the of tSDCS treatment, the levels of trait anxiety (Q1=29.00 ; Me=37.00 ; Q3=42.00; p=0.021) and depression estimated from the Tsung scale (Q1=2.85; Me=3.00; Q3=3.60; p=0.014) and the cognitive-affective scale of Beck (Q1=0.50; Me=2.00; Q3=5.50; p=0.041) were significantly lower than in the boys of the control group. The level of depression based on the Tsung scale was significantly lower (p=0.020) in the boys and after the standard spa and health resort-based treatment (Q1=2.50; Me=2.90; Q3=3.60) was comparable with that in the boys of the control group (Q1=4.00; Me=4.60; Q3=4.80). CONCLUSION: The present study has demonstrated the expediency of inclusion of a course of transcutaneous spinal direct current stimulation in the programs of the combined spa and health resort-based treatment for the adolescents presenting with scoliosis.

[The isolation of organic compounds from hydrosulfuric mineral waters with the use of the extractive freezing-out technique with centrifugation]. / Vydelenie organicheskikh veshchestv iz serovodorodnykh mineral'nykh vod metodom ekstraktsionnogo vymorazhivaniya s tsentrifugirovaniem.

The mineral waters, enriched with organic substances find extensive application in balneotherapy. The fast and efficient methods for the identification and quantitative measurement of organic compounds (in the first place, organic acids) in such waters need to be developed for the estimation of their quality and biological activity. AIM: The objective of the present study was to elaborate a gas chromatographic method for the determination of monobasic carbonic acids in sulfide-containing mineral waters by means of extractive freezing-out in combination with the application of the centrifugal forces for the elucidation of the metrological characteristics of the compounds of interest. The secondary objective was to estimate the prospects for the application of the method of interest for determining the dissolved organic compounds in mineral waters. MATERIAL AND METHODS: The following carbonic acids were used for the purposes of the study: acetic acid (analytical grade), Russia; propionic grade (extra pure), Ferak, Germany; butyric acid (pure), Russia; valeric acid (pure), Russia; caproic acid (pure), Russia; oenanthic acid (pure), Russia; and caprylic acid (pure), Russia). Acetonitrile («O¼ grade), Russia, was used as the extracting agent. The LV-210 analytical balance (Russia) was used to prepare the model and standard solutions of the organic compounds and to determine their mass. The extracts and standard mixture were investigated by the gas chromatographic technique with the use of the Kristallyuks apparatus («Meta-Khrom¼, Russia) equipped with the flame ionization detector and the capillary column. Extractive freezing-out in the combination with centrifugation was performed with the laboratory installation for this purpose. RESULTS: Under the model conditions, a single extractive freezing-out procedure with the centrifugation of the sample made it possible to reach the 22-37-fold concentration of C2-C8 monobasic carbonic acids during their transfer from water into acetonitrile. The metrological parameters of the proposed procedure for gas-chromatographic determination of the aforementioned acids in hydrosulfuric mineral waters were estimated. The limit of detection of acetic and propionic acids has been 0,2 mg/l, that for butyric acid 0,1 mg/l, for valeric, caproic, oenanthic and caprylic acids 0,05 mg/l. We failed to identify C2-C8 carbonic acids in hydrosulfuric water from the 6T well of the field Matsesta fields. The investigation of the extracts obtained by the proposed extraction procedure with the use of the newly developed variant of high performance liquid chromatography (HPLC) with diode-matrix detection revealed the presence of various amounts of unknown organic substances. The UV-spectrum of one of those components was obtained which made it possible to conjecture its molecular structure. The procedure for the sample preparation and the following determination of organic acids in water is simple, carried out in a single stage, and does not impose special requirements to the qualification of the researcher. It allows to describe the newly developed technique as a rapid test method. Along with it, realization of extraction in the negative temperature mode reduces the risk of decomposition of the thermally unstable chemical compounds being extracted and reduces volatility of the organic solvents being used. The technology of the method does not demand a special laboratory glassware and expendables.

O poder terapêutico das águas minerais em Minas Gerais: do conhecimento popular ao científico / The therapeutic power of mineral waters in Minas Gerais: from popular to scientific knowledge

O uso das águas minerais para tratamento de saúde é um procedimento dos mais antigos, utilizado desde a época do Império Grego, recebeu vários nomes ao longo dos anos: Hidrologia Médica, Crenoterapia e Termalismo. No Brasil, a Crenoterapia foi introduzida juntamente com a colonização portuguesa, que trouxe ao país os seus hábitos de usar águas minerais para tratamento de saúde. A princípio, principalmente nos séculos XVII e XVIII, as águas tinham o seu poder curativo comprovado por experiências práticas e eram relacionadas ao mundo religioso, sendo, por isso, consideradas sagradas e milagrosas. As fontes de águas minerais foram as responsáveis pela formação e desenvolvimento de muitas cidades em Minas Gerais, atraindo a vinda de vários viajantes interessados no poder curativo e milagroso das águas. O sucesso do tratamento de doenças, com os banhos de águas minerais transformou lugarejos em centros urbanos. O potencial econômico das águas minerais, ao logo dos anos, despertou a atenção dos governantes mineiros, que passaram a realizar investimentos nas cidades que possuíam estâncias hidrominerais. Essas cidades, aos olhos dos governantes, tinham potencial para representar o grau de progresso e civilização almejado pelo Estado de Minas Gerais. No entanto, além da higiene, segurança e conforto, fazia-se necessário atingir outros patamares quanto à cientificidade para a indicação terapêutica das águas minerais. Assim, entra em cena a Universidade de Minas Gerais, que foi criada em 07 de setembro de 1927, pela Lei 956, promulgada pelo então Presidente do Estado de Minas Gerais, Antônio Carlos Ribeiro de Andrada. A análise dos documentos durante a pesquisa revelou a existência de um acordo...

The use of mineral waters for health treatment purpose, is not a new procedure, being used since the Greek Empire times, has received several names over the years: Medical Hydrology, Cotherapy and Thermalism. In Brazil the crenoterapia was introduced by the Portuguese colonization, which brought to the country the habits of using mineral waters for health treatment. At first, especially in the seventeenth and eighteenth centuries, the waters had their curative power, proved by practical experience and was linked to the religious world, and therefore considered sacred and miraculous. The sources of mineral waters were responsible for the beginning and development of many cities in Minas Gerais, attracting several travelers interested in the curative and miraculous power of the waters. The success of disease treatment through mineral water baths has turned hamlets into urban centers. The economic potential of the mineral waters, at the turn of the years, attracted the attention of the mining rulers, who began to invest in the cities that had hydro-mineral spots. These, in the eyes of the rulers, had the potential to represent the degree of progress and civilization sought by the State of Minas Gerais. However, besides hygiene, safety and comfort, it was necessary to reach other levels as the scientific knowledge to correct therapeutic indication of the mineral waters. Thus, the University of Minas Gerais, which was created on September 7, 1927 by Law 956, was promulgated by the President of the State of Minas Gerais, Antônio Carlos Ribeiro de Andrada. The analysis of the documents during the research revealed the existence of an agreement between the President of the State in the year 1927 and the director of the Faculty of Medicine for the creation of the University of Minas Gerais. The importance of hydromineral stations to the state and the need to legitimize scientific knowledge for water therapy led the President of the State to support...

Musculoskeletal Health Conditions Represent a Global Threat to Healthy Aging: A Report for the 2015 World Health Organization World Report on Ageing and Health.

Persistent pain, impaired mobility and function, and reduced quality of life and mental well-being are the most common experiences associated with musculoskeletal conditions, of which there are more than 150 types. The prevalence and impact of musculoskeletal conditions increase with aging. A profound burden of musculoskeletal disease exists in developed and developing nations. Notably, this burden far exceeds service capacity. Population growth, aging, and sedentary lifestyles, particularly in developing countries, will create a crisis for population health that requires a multisystem response with musculoskeletal health services as a critical component. Globally, there is an emphasis on maintaining an active lifestyle to reduce the impacts of obesity, cardiovascular conditions, cancer, osteoporosis, and diabetes in older people. Painful musculoskeletal conditions, however, profoundly limit the ability of people to make these lifestyle changes. A strong relationship exists between painful musculoskeletal conditions and a reduced capacity to engage in physical activity resulting in functional decline, frailty, reduced well-being, and loss of independence. Multilevel strategies and approaches to care that adopt a whole person approach are needed to address the impact of impaired musculoskeletal health and its sequelae. Effective strategies are available to address the impact of musculoskeletal conditions; some are of low cost (e.g., primary care-based interventions) but others are expensive and, as such, are usually only feasible for developed nations. In developing nations, it is crucial that any reform or development initiatives, including research, must adhere to the principles of development effectiveness to avoid doing harm to the health systems in these settings.

Measuring Indoor Air Quality and Engaging California Indian Stakeholders at the Win-River Resort and Casino: Collaborative Smoke-Free Policy Development.

Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM2.5 personal exposure, area concentrations of airborne nicotine and PM2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.

Activity of Dr Józef Aleksiewicz, PhD, Towards the Development of Orthopedics and Rehabilitation in Lviv in the Years 1912-1930.

The article describes the work of Dr Aleksiewicz towards the development of orthopedics and rehabilitation in Lviv in the years 1912-1930 based on source materials belonging to his family and articles published in medical journals and daily press. In 1919, Dr Aleksiewicz established a Surgical and Orthopedic Department and a factory of prostheses at the Disabled House in Lviv. He also formed a 200-bed division for the visually impaired with basket- and comb-making workshops as well as massage and typing courses. It was an innovative undertaking aiming to provide surgical treatment, orthopaedic aids and rehabilitation for victims of World War I. From 1919, Dr Aleksiewicz ran his Private Orthopedic Clinic with Factory of orthopaedic aids and pro-stheses" at 2 Friedrichów St. in Lviv. He specialised in therapy of surgical tuberculosis, fractures, dislocations and abnormal spinal curvatures. His work in Lviv in the period 1912-1930 undeniably contributed to the development of orthopaedics and rehabilitation, which were new medical specialties at the time.

Dr. Józef Aleksiewicz Activity in Support of the Development of Orthopedics and Rehabilitation in Iwonicz-Zdrój (1921-1957).

Based on source materials in the possession of Józef Aleksiewicz family (typescripts, manuscripts, photographs, other documents) and articles published in professional medical journals and newspapers, the authors present the contribution of Dr. J. Aleksiewicz to the development of orthopedics and rehabilitation in Iwonicz-Zdrój. In May 1921, he was appointed Surgeon General of the Spa Commission in Iwonicz-Zdrój. After holding several scholarly trips abroad in 1925 to sanatoriums treating cases of osteo-articular tuberculosis, he commenced the construction of "Sanato", a modern sanatorium. Opened in 1930, it was the only center in Poland treating osteo-articular tuberculosis in a spa setting. It was the first orthopedic rehabilitation center in what is now Podkarpackie Voivodship offering diagnostic work-up, surgery and conservative treatment of osteo-articular tuberculosis in children. Modelled on the best Western centers, Dr. Aleksiewicz widely employed physical methods, such as Swedish therapeutic gymnastics, mechanotherapy, massage, physical therapy and hydrotherapy.

[The multifunctional therapy of various forms of irritable bowel syndrome]. / Mnogofunktsional'naya terapiya pri razlichnykh formakh sindroma razdrazhennogo kishechnika.

Irritable bowel syndrome (IBS) is a pathological condition characterized by heterogeneous etiology, pathogenesis, and clinical symptoms. These characteristics dictate the necessity of prescribing multiple medications for the treatment of IBS. Such compulsory polypharmacy inadvertently enhances the risk of adverse reactions to the treatment, increases its cost, and impairs compliance on the part of the patients. The objective of the present study was to evaluate the effectiveness of the administration of the clorine-bromine brine with the use of sinusoidal modulated current electrophoresis (SMC-phoresis) for the treatment of different forms of IBS. THE PATIENTS AND METHODS: We examined and treated 80 patients with different forms of IBS. The patients were divided into two equal groups comprised of 40 patients each. The patients of the study group were treated with the use of SMС-phoresis of the bromine-chlorine brine based at the «Varzi-yatchi¼ spa and health resort (the Udmurt Republic) making use of the sparing or stimulating techniques depending on the type of IBS. Each therapeutic course consisted of 10-12 sessions. The patients in the group of comparison received the standard pharmaceutical treatment for IBS (myotropic anti-spasmodics and lactulose). The emphasis was laid on the evaluation of dynamics of the intestinal motor function in different variants of IBS with the use of the EGS-4M apparatus based on the GSRS questionnaire (Gastrointestinal Symptom Rating Scale). Special attention was given to the interpretation of the main gastrointestinal syndromes and the evaluation of the quality of life of the patients in the course of the treatment and after its completion. RESULTS: Тhe main symptoms of IBS after a course of SMC-phoresis with the natural brine were significantly less pronounced compared to those in the patients managed by means of standard pharmacotherapy. Positive dynamics in the clinical picture of the disease had beneficial influence on the quality of life of the patients which approached that of the healthy subjects in the group of comparison. The results of colonography suggested the presence of various types of disturbances of motor function of the intestines. SMC-phoresis of the natural chlorine-bromine brine had a positive influence on dyskinesia associated with diarrhea and constipation associated with IBS, while the effect of the standard pharmaceutical treatment was unidirectional and significantly inferior to it in terms of efficiency. CONCLUSION: The use of complementary therapy can provide a better clinical outcome of IBS and to a greater extent improve the quality of life of the patients presenting with various forms of this pathology.

[Experience of the military sanatorium "Arkhangelsk" on medical rehabilitation of patients after surgery].

Experience of the military sanatorium <> on medical rehabilitation of patients after surgery in the treatment of coronary heart disease. Showing features of the organization of medical rehabilitation of patients with coronary artery disease after surgical treatment at a sanatorium stage. The technology of application of restorative treatment, physical and psychological recovery, natural and premature medicinal factors are given. Based on the dynamics of the functional status of patients given control of complex clinical and instrumental studies in comparison with analogous-tech at discharge, to translate them into functional class, characterized with greater functionality is installed, the high efficiency of rehabilitation.

Rationale, design, samples, and baseline sun protection in a randomized trial on a skin cancer prevention intervention in resort environments.

INTRODUCTION: Exposure to solar ultraviolet radiation during recreation is a risk factor for skin cancer. A trial evaluated an intervention to promote advanced sun protection (sunscreen pre-application/reapplication; protective hats and clothing; use of shade) during vacations. MATERIALS AND METHODS: Adult visitors to hotels/resorts with outdoor recreation (i.e., vacationers) participated in a group-randomized pretest-posttest controlled quasi-experimental design in 2012-14. Hotels/resorts were pair-matched and randomly assigned to the intervention or untreated control group. Sun. protection (e.g., clothing, hats, shade and sunscreen) was measured in cross-sectional samples by observation and a face-to-face intercept survey during two-day visits. RESULTS: Initially, 41 hotel/resorts (11%) participated but 4 dropped out before posttest. Hotel/resorts were diverse (employees=30 to 900; latitude=24° 78' N to 50° 52' N; elevation=2ft. to 9726ft. above sea level), and had a variety of outdoor venues (beaches/pools, court/lawn games, golf courses, common areas, and chairlifts). At pretest, 4347 vacationers were observed and 3531 surveyed. More females were surveyed (61%) than observed (50%). Vacationers were mostly 35-60years old, highly educated (college education=68%) and non-Hispanic white (93%), with high-risk skin types (22%). Vacationers reported covering 60% of their skin with clothing. Also, 40% of vacationers used shade; 60% applied sunscreen; and 42% had been sunburned. CONCLUSIONS: The trial faced challenges recruiting resorts but result showed that the large, multi-state sample of vacationers were at high risk for solar UV exposure.