Spa environments in central Serbia: Geothermal potential, radioactivity, heavy metals and PAHs.

This study aims to estimate geothermal potential, radioactivity levels, and environmental pollution of six most popular spas in Central Serbia (Ovcar, Gornja Trepca, Vrnjacka, Mataruska, Bogutovacka 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 Mataruska 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.

Natural medicinal resources and their therapeutic applications

Natural medicinal resources are a country's natural wealth. Natural medicinal waters, medicinal gases, and peloids have many properties that enable their use in the treatment of gastrointestinal, circulatory, respiratory, bone and joint, and skin and soft tissue disorders. Balneotherapy can be also applicable in prevention of many diseases and rehabilitation. At present, because there are several chemicals of synthetic origin, there is a need to search for nonpharmacological approaches and explore natural healing sources, which better fit the human body. Compared to synthetic drugs, these resources rarely show side effects, which increases the comfort of therapy. The use of natural medicinal resources in the form of treatments in health resort medicine centers under the supervision of balneologists, combined with the healing properties of the climate, contributes not only to the reduction of treatment time for many diseases but also to improvement of therapy's results. The article discusses natural medicinal resources and some of their therapeutic applications.

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Legionella pneumophilla bacteria in thermal saline bath.

OBJECTIVE: The study was aimed at determining whether Legionella pneumophila bacteria can be found in thermal saline waters used in balneotherapy. METHODS: Water samples were collected from three thermal saline baths, supplied by thermal saline waters (type Cl - Na). The total number of bacteria was determined in the direct microscopic count under a fluorescence microscope The numbers of bacteria belonging to different phylogenetic groups (Eubacteria, Legionella sp. and Legionella pneumophila) were determined with the use of a molecular FISH method. RESULTS: The highest average total number of bacteria as well as the highest average number of Eubacteria in the entire research cycle was recorded in bath 1. Bacteria belonging to the Legionella genus along with Legionella pneumophila were identified in all water samples collected from each bath. Moreover, biofilm containing cells of L. pneumophilla was identified in the collected water samples. CONCLUSION: The number of bacteria in water increases with the bath's age. The Legionella pneumophila can successfully develop not only in fresh water bodies but in thermal saline baths as well. Still, it is uncertain whether the commonly applied culture method, developed for freshwater bodies, is also suitable for thermal saline baths.

A checklist to assess the quality of reports on spa therapy and balneotherapy trials was developed using the Delphi consensus method: the SPAC checklist.

OBJECTIVE: The purpose of this study was to develop a checklist of items that describes and measures the quality of reports of interventional trials assessing spa therapy. METHODS: The Delphi consensus method was used to select the number of items in the checklist. A total of eight individuals participated, including an epidemiologist, a clinical research methodologist, clinical researchers, a medical journalist, and a health fitness programmer. Participants ranked on a 9-point Likert scale whether an item should be included in the checklist. RESULTS: Three rounds of the Delphi method were conducted to achieve consensus. The final checklist contained 19 items, with items related to title, place of implementation (specificity of spa), care provider influence, and additional measures to minimize the potential bias from withdrawals, loss to follow-up, and low treatment adherence. CONCLUSION: This checklist is simple and quick to complete, and should help clinicians and researchers critically appraise the medical and healthcare literature, reviewers assess the quality of reports included in systematic reviews, and researchers plan interventional trials of spa therapy.

[Spa facilities and legionellosis: legislative structure and state of the art in Apulia (Italy)]. / Strutture termali e legionellosi: quadri normativi e stato dell'arte in Puglia.

A number of factors, for example water temperature, can encourage the growth of microorganisms such as Legionella spp in spa facilities. Individuals who attend this type of facility are often subjects at risk for infection who are undergoing inhalation therapy and hot tub treatments. A very accurate management of these facilities is therefore required to avoid infection by Legionella spp. The purpose of this study was to verify the current Italian national and Apulia regional legislation regarding the control of contamination by Legionella spp. in spa facilities.

[The organization of provision of spa-and-resort services for the population of the russian Federation (part 2). Spa and resort institutions].

The main principles of the organization of medical activities of spa and resort institutions including children's and tuberculosis (phtysiatric) ones are discussed in conjunction with the relative normative and legal acts.

[The health improving technologies in pediatrics].

The development of prophylactic treatment is one of most challenging and socially significant aspects of modern pediatrics. Today, a great variety of natural and artificial physical factors are employed to protect and/or restore the health of the children and to improve it. The broad scope of non-medicamentous technologies used for the purpose makes it possible to elaborate prophylactic programs adapted to the specific requirements of individual patients at all levels of medical care including therapeutic and prophylactic, spa and resort institutions, educational institutions, health improvement and recreational camps of different types, and home care.

[Hygienic evaluation of mineral therapy conditions].

Physiological and hygienic investigations conducted in the underground structures and different types of above-ground ones made of natural sylvinite have provided evidence for the modes of their maintenance and methods for correcting the internal environment to enhance therapeutic effectiveness in patients.

[On the selected problems of the involvement of spa-and-resort facilities in the implementation of territorial programs of compulsory medical insurance].

The inclusion of spa-and-resort facilities in the sphere of compulsory medical insurance is in accordance with the law "On the compulsory medical insurance in the Russian Federation". However, this work implies serious preparatory activity aimed at estimating the requirements of different groups of the country's population in the follow-up treatment and rehabilitation based at the spa-and-resort facilities as well as the available resources for this purpose, modes of payment, rate structure, etc. The spa and resort-based treatment within the framework of the compulsory medical insurance system must be made one of the components of the regional programs of medical rehabilitation.

[Thermal water for recreational use: overview of international standards]. / Acque termali per uso ricreativo: panoramica sulle normative internazionali.

The use of thermal waters in swimming pools for recreational use is widespread in Europe and in the rest of the world. The biological and chemical properties of spa waters make it difficult to treat them with conventional disinfection methods. The authors present an overview of European and international laws and regulations on this subject and highlight their strengths and gaps.

[Determination of barium in natural curative waters by ICP-OES technique. Part I. Waters taken on the area of health resorts in Poland]. / Oznaczanie baru w naturalnych wodach leczniczych technika ICP-OES. Czesc I. Wody ujmowane na terenach uzdrowisk w Polsce.

Maximum admissible concentration level (MACL) of barium in natural mineral waters, natural spring waters and potable waters was set at the level of 1 mg/l, while MACL of this element in natural curative waters intended for drinking therapies and inhalations were set at the levels of 1.0 mg/l and 10.0 mg/l, respectively. Those requirements were related to therapies which are applied longer than one month. Above mentioned maximum admissible concentration levels of barium in consumed waters were established after taking into account actual criteria of World Health Organization which determined the guidelines value for this element in water intended for human consumption at the level of 0.7 mg/l. In this work developed and validated method of determination of barium by inductively coupled plasma emission spectrometry technique was applied for determination of this element in 45 natural curative waters sampled from 24 spa districts situated on the area of Poland. Concentrations of barium determined were in the range from 0.0036 mg/l to 24.0 mg/l. Natural curative waters characterized by concentrations of barium in the ranges of 0.0036 - 0.073 mg/l, 0.0036 - 1.31 mg/l and 0.0036 - 24.0 mg/l, were applied to drinking therapy, inhalations and balneotherapy, respectively (some of waters analyzed were simultaneously applied to drinking therapy, inhalations and balneotherapy). In the cases of 11 natural curative waters exceeding limit of 1 mg/l were observed, however they were classified mainly as waters applied to balneotherapy and in two cases to inhalation therapies (concentrations of barium - 1.08 mg/l and 1.31 mg/l). The procedure of classification of curative waters for adequate therapies based among other things on barium concentrations meets requirements of the Decree of Minister of Health from 13 April 2006 on the range of studies indispensable for establishing medicinal properties of natural curative materials and curative properties of climate, criteria of their assessment and a specimen of certificate confirmed those properties.

[The present-day organization of spa and resort services for the population of the Russian Federation (Part 1)].

The main principles underlying the present-day organization of spa and resort services for the population of the Russian Federation are described. The emphasis is laid on the procedures for the selection and referral to spa and resort facilities of the patients, both adults and children, in need of balneotherapeutic treatment. The relevant normative and legal regulations are discussed.

[Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability].

Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology.

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.

Balneotherapy versus paroxetine in the treatment of generalized anxiety disorder.

INTRODUCTION: Preliminary studies have suggested that balneotherapy (BT) is an effective and well-tolerated treatment for generalized anxiety disorder (GAD) and psychotropic medication withdrawal syndrome. We carried out a study in 4 spa resorts to assess the efficacy of BT in GAD. METHOD: We compared BT to paroxetine in terms of efficacy and safety in a randomized multicentre study lasting 8 weeks. Patients meeting the diagnostic criteria of GAD (DSM-IV) were recruited. Assessments were conducted using the Hamilton Rating Scale for Anxiety (HAM-A) and other scales, by a specifically trained and independent physician. The primary outcome measure was the change in the total HAM-A score between baseline and week 8. RESULTS: A total of 237 outpatients were enrolled in four centres; 117 were assigned randomly to BT and 120 to paroxetine. The mean change in HAM-A scores showed an improvement in both groups with a significant advantage of BT compared to paroxetine (-12.0 vs -8.7; p<0.001). Remission and sustained response rates were also significantly higher in the BT group (respectively 19% vs 7% and 51% vs 28%). CONCLUSION: BT is an interesting way of treating GAD. Due to its safety profile it could also be tested in resistant forms of generalized anxiety and in patients who do not tolerate or are reluctant to use pharmacotherapies.

Medical-legal considerations in the medical spa environment.

A better understanding of the medical-legal considerations of the medical spa environment plays a role in promoting a successful medical spa. The medical spa setting is ideal for the performance of procedures that are incision-less, provide minimal discomfort, create little to no skin wound, and are performed in less than one hour. The procedures that fit this model include those that promote antiaging, those that lead to rhytid treatment, and hair removal.