Association between habitual hot spring bathing and depression in Japanese older adults: A retrospective study in Beppu.

OBJECTIVES: Thermal therapy is used to manage various psychological diseases, such as depression. We investigated the relationship between hot spring bathing and depression in older adults using questionnaire responses. DESIGN AND SETTING: We comprehensively evaluated the preventive effects of long-term hot spring bathing in 10429 adults aged ≥ 65 years in Beppu, Japan, by conducting a questionnaire study on the prevalence of depression (n = 219). MAIN OUTCOME MEASURES: Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a multivariable logistic regression model for history of depression. RESULTS: A separate multivariable logistic regression model for inference showed that female sex (OR, 1.56; 95 % CI, 1.17-2.08; p = 0.002), arrhythmia (OR, 1.73; 95 % CI, 1.18-2.52; p = 0.004), hyperlipidemia (OR, 1.63; 95 % CI, 1.14-2.32; p = 0.006), renal disease (OR, 2.26; 95 % CI, 1.36-3.75; p = 0.001), collagen disease (OR, 2.72; 95 % CI, 1.48-5.02; p = 0.001), allergy (OR, 1.97; 95 % CI, 1.27-3.04; p = 0.002), and habitual daily hot spring bathing (OR, 0.63; 95 % CI, 0.41-0.94; p = 0.027) were independently significantly associated with a history of depression. CONCLUSIONS: We found an inverse relationship between habitual daily hot spring bathing and history of depression. Prospective randomized controlled trials on habitual daily hot spring bathing as a treatment for depression are warranted to investigate whether the use of hot springs can provide relief to those with psychiatric and mental health disorders.

Thermal Endurance by a Hot-Spring-Dwelling Phylogenetic Relative of the Mesophilic Paracoccus.

High temperature growth/survival was revealed in a phylogenetic relative (SMMA_5) of the mesophilic Paracoccus isolated from the 78 to 85°C water of a Trans-Himalayan sulfur-borax spring. After 12 h at 50°C, or 45 min at 70°C, in mineral salts thiosulfate (MST) medium, SMMA_5 retained ~2% colony forming units (CFUs), whereas comparator Paracoccus had 1.5% and 0% CFU left at 50°C and 70°C, respectively. After 12 h at 50°C, the thermally conditioned sibling SMMA_5_TC exhibited an ~1.5 time increase in CFU count; after 45 min at 70°C, SMMA_5_TC had 7% of the initial CFU count. 1,000-times diluted Reasoner's 2A medium, and MST supplemented with lithium, boron, or glycine-betaine, supported higher CFU-retention/CFU-growth than MST. Furthermore, with or without lithium/boron/glycine-betaine, a higher percentage of cells always remained metabolically active, compared with what percentage formed single colonies. SMMA_5, compared with other Paracoccus, contained 335 unique genes: of these, 186 encoded hypothetical proteins, and 83 belonged to orthology groups, which again corresponded mostly to DNA replication/recombination/repair, transcription, secondary metabolism, and inorganic ion transport/metabolism. The SMMA_5 genome was relatively enriched in cell wall/membrane/envelope biogenesis, and amino acid metabolism. SMMA_5 and SMMA_5_TC mutually possessed 43 nucleotide polymorphisms, of which 18 were in protein-coding genes with 13 nonsynonymous and seven radical amino acid replacements. Such biochemical and biophysical mechanisms could be involved in thermal stress mitigation which streamline the cells' energy and resources toward system-maintenance and macromolecule-stabilization, thereby relinquishing cell-division for cell-viability. Thermal conditioning apparently helped inherit those potential metabolic states which are crucial for cell-system maintenance, while environmental solutes augmented the indigenous stability-conferring mechanisms. IMPORTANCE For a holistic understanding of microbial life's high-temperature adaptation, it is imperative to explore the biology of the phylogenetic relatives of mesophilic bacteria which get stochastically introduced to geographically and geologically diverse hot spring systems by local geodynamic forces. Here, in vitro endurance of high heat up to the extent of growth under special (habitat-inspired) conditions was discovered in a hot-spring-dwelling phylogenetic relative of the mesophilic Paracoccus species. Thermal conditioning, extreme oligotrophy, metabolic deceleration, presence of certain habitat-specific inorganic/organic solutes, and potential genomic specializations were found to be the major enablers of this conditional (acquired) thermophilicity. Feasibility of such phenomena across the taxonomic spectrum can well be paradigm changing for the established scopes of microbial adaptation to the physicochemical extremes. Applications of conditional thermophilicity in microbial process biotechnology may be far reaching and multifaceted.

Penicillactonin and preaustinoid C, lactone-containing metabolites from a hot spring sediment Penicillium sp.

Phytochemical investigation of Penicillium sp. RO-11 strain, collected from the sediments of a hydrothermal spring located in the southwestern area of Saudi Arabia, afforded, along with previously isolated compounds, the undescribed polyketides penicillactonin (1), penipyranicin D (4) and isopyrenulin B (5) and the undescribed meroterpenoid preaustinoid C (7). The structures of these compounds were elucidated based on data from mass spectrometry, 1D and 2D NMR, and comparison between experimental and calculated ECD spectra. Penicillactonin and preaustinoid C bring unprecedented structural features, for which a biosynthetic rationale is proposed, further extending the chemodiversity associated to Penicillium fungi. Preaustinoid C showed significant activity against LPS-induced NO production and selective effect on IL-2 and IFN-γ gene regulation in activated Jurkat cells.

Screening and isolation of microbes from a Mud Community of Ischia Island Thermal Springs: preliminary analysis of a bioactive compound.

INTRODUCTION: Balneotherapy centers of Ischia island (Italy) offer treatments for different dermatological diseases (psoriasis, acne, atopic dermatitis) and upper respiratory tract infections. In this study, we integrated morphological and molecular approaches to give a focus on isolation and screening of extremophile bacteria from Ischia thermal mud for potential antimicrobial applications. METHODS: Samples were collected during 2019 at four sites. Some bacterial strains ATCC for antibacterial and antibiofilm activity were tested. After morphological characterization, screening for antagonistic isolates was made. The colonies isolated from thermal mud samples were submitted to molecular characterization. Susceptibility testing by dilution spotting was carried out and antibacterial efficacies of most active isolate were evaluated with a Minimal inhibition concentration assay. Biofilm formation, inhibition, eradication were examined. Statistical analyses were carried out utilizing Microsoft® Excel 2016/XLSTAT©-Pro. RESULTS: We isolated a natural compound with antimicrobial and antibiofilm activities. CONCLUSIONS: The results obtained in this study are discussed in the context of how hydrothermal systems are important environmental source of uncharted antimicrobial and antibiofilm compounds. In conclusion, to the most effective of our knowledge, this work presents the primary report on the preliminary investigation of thermophile microbial diversity and their antimicrobial and antibiofilm activities for future biotechnological interest.

Balneotherapy for Musculoskeletal Pain Management of Hot Spring Water in Southern Ethiopia: Perceived Improvements.

Background: Balneotherapy and hydrotherapy offer interesting treatment alternatives and are commonly used as additional interventions in the management of musculoskeletal disorders and pain management. Therefore, the aim of this study was to assess the effect of balneotherapy on musculoskeletal disorder pain and its perceived improvement among users of hot spring water in Southern Ethiopia. Methods: A single-arm cohort study and convenient sampling method were used to select 1337 study participants from four hot springs in Southern Ethiopia. A structured questionnaire, a physical examination, and laboratory blood tests were used to collect data. Data were entered using Epi data and transferred to SPSS 25 for cleaning and analysis. Descriptive analysis was made. Results: A total of 1279 participants were included in the study, giving a response rate of 96%. The majority of these patients have multiple health problems. Of all, 1137 (88.9%) of the patients were visiting the hot springs for joint pain followed by muscle pain 669 (52.2). Out of all cases of joint pain, 132 (11.6%) were clinically diagnosed with rheumatoid arthritis, and 5.3% were confirmed as having the disease based on a laboratory test. Of the total number of study participants, 1064 (83.2%) reported complete relief from the complaints they had at the start of the bath. Conclusions: Hot spring baths for three and more days have significant therapeutic effects on patients with musculoskeletal disorders, including rheumatoid arthritis. Physicians who are currently working in the area of diagnosis and treatment of patients in government and public facilities of the southern region should consider hot spring bath treatment for those patients with complaints of musculoskeletal pain, nonspecific arthritis, and rheumatoid arthritis. A hot spring bath is beneficial for everyone because it is a natural treatment with few side effects and a low cost.

Inhalations with thermal waters in respiratory diseases.

ETHNOPHARMACOLOGICAL RELEVANCE: Inhalations with thermal waters are an old therapeutic method used in the therapy of respiratory diseases as a treatment of choice showing a long-lasting outcome with no side effects. Paradoxically, there is little well-established research on their mechanisms of action. AIM OF THE STUDY: The aim of this paper is therefore to summarize the influence of inhalatory treatment with thermal waters on the main symptoms and features of respiratory disorders including allergy-like symptoms, inflammation, oxidant-anti-oxidant balance, cellular influx, disturbed mucus secretions, recurrent infections, pulmonary and nasal function and quality of life. A short history of inhalations is also presented. MATERIALS AND METHODS: The present paper is a sum-up of research articles on the use of inhalations with thermal waters in respiratory disorders. RESULTS: According to the herein presented literature, the use of thermal water inhalations is beneficial for almost all manifestations of respiratory diseases. The mode of their action remains still unclear; however, it seems that the most important one relies on the restoration of proper defense mechanisms of the organism. CONCLUSIONS: Inhalations with thermal waters alleviate symptoms of respiratory diseases. They also improve the quality of life of the patients and seem to be a good add-on therapy in the treatment of disorders of the respiratory system.

The Thermosynechococcus Genus: Wide Environmental Distribution, but a Highly Conserved Genomic Core.

Cyanobacteria thrive in diverse environments. However, questions remain about possible growth limitations in ancient environmental conditions. As a single genus, the Thermosynechococcus are cosmopolitan and live in chemically diverse habitats. To understand the genetic basis for this, we compared the protein coding component of Thermosynechococcus genomes. Supplementing the known genetic diversity of Thermosynechococcus, we report draft metagenome-assembled genomes of two Thermosynechococcus recovered from ferrous carbonate hot springs in Japan. We find that as a genus, Thermosynechococcus is genomically conserved, having a small pan-genome with few accessory genes per individual strain as well as few genes that are unique to the genus. Furthermore, by comparing orthologous protein groups, including an analysis of genes encoding proteins with an iron related function (uptake, storage or utilization), no clear differences in genetic content, or adaptive mechanisms could be detected between genus members, despite the range of environments they inhabit. Overall, our results highlight a seemingly innate ability for Thermosynechococcus to inhabit diverse habitats without having undergone substantial genomic adaptation to accommodate this. The finding of Thermosynechococcus in both hot and high iron environments without adaptation recognizable from the perspective of the proteome has implications for understanding the basis of thermophily within this clade, and also for understanding the possible genetic basis for high iron tolerance in cyanobacteria on early Earth. The conserved core genome may be indicative of an allopatric lifestyle-or reduced genetic complexity of hot spring habitats relative to other environments.

Impact of Avène Thermal Spring Water on immune cells.

The hydrotherapy centre in Avène, France, is used extensively to treat inflammatory skin diseases. Nevertheless, the immune mechanisms targeted by Avène Thermal Spring Water (TSW) are not fully understood. Here, we review the main results reported regarding the effects of Avène TSW on the immune system. In particular, mast cells, dendritic cells (DCs) and CD4+ T cells have been shown to be modulated by Avène TSW. All in all, the studies carried out on the effects of Avène TSW on leucocytes indicate that this water is endowed with a tolerogenic potential.

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.

COMPARISON OF THE RADIO-ISOTOPIC COMPOSITION BETWEEN HOT SPRING WATER OF HAMMAM DEBAGH AND ITS ASSOCIATED DEPOSITS.

A radiological analysis of hot spring water of Hammam Debagh (also called Hammam Meskhoutine) and its associated deposits was realized. Hammam Debagh is considered to be the second hottest springs in the world with a temperature of 98°C and this lead to the creation of travertine. This later was formed because of limestone deposited by mineral springs in a rapid sedimentation of calcium, magnesium bicarbonates, and sulphides. The analysis showed that two-thirds of radioactivity was left by spring water in their deposits. The presence of uranium in the spring deposits was due to the property of the uranyl ion to form stable complexes with carbonates and precipitates. The radiation hazards indexes were estimated and compared with those given in literature.

Biodegradation of mixed polycyclic aromatic hydrocarbons by pure and mixed cultures of biosurfactant producing thermophilic and thermo-tolerant bacteria.

Applicability of thermophilic and thermo-tolerant microorganisms for biodegradation of polycyclic aromatic hydrocarbons (PAHs) with low water solubility is an interesting strategy for improving the biodegradation efficiency. In this study, we evaluated utility of thermophilic and thermo-tolerant bacteria isolated from Unkeshwar hot spring (India) for biodegradation of four different PAHs. Water samples were enriched in mineral salt medium (MSM) containing a mixture of four PAHs compounds (anthracene: ANT, fluorene: FLU, phenanthrene: PHE and pyrene: PYR) at 37 °C and 50 °C. After growth based screening, four potent strains obtained which were identified as Aeribacillus pallidus (UCPS2), Bacillus axarquiensis (UCPD1), Bacillus siamensis (GHP76) and Bacillus subtilis subsp. inaquosorum (U277) based on the 16S rRNA gene sequence analysis. Degradation of mixed PAH compounds was evaluated by pure as well as mixed cultures under shake flask conditions using MSM supplemented with 200 mg/L concentration of PAHs (50 mg/L of each compound) for 15 days at 37 °C and 50 °C. A relatively higher degradation of ANT (92%- 96%), FLU (83% - 86%), PHE (16% - 54%) and PYR (51% - 71%) was achieved at 50 °C by Aeribacillus sp. (UCPS2) and mixed culture. Furthermore, crude oil was used as a substrate to study the degradation of same PAHs using these organisms which also revealed with similar results with the higher degradation at 50 °C. Interestingly, PAH-degrading strains were also positive for biosurfactant production. Biosurfactants were identified as the variants of surfactins (lipopeptide biosurfactants) based on analytical tools and phylogenetic analysis of the surfactin genes. Overall, this study has shown that hot spring microbes may have a potential for PAHs degradation and also biosurfactant production at a higher temperature, which could provide a novel perspective for removal of PAHs residues from oil contaminated sites.

Is the Duration of Spa Cure Treatment Important in Knee Osteoarthritis? A Randomized Controlled Study.

BACKGROUND: Spa therapies are applied in varying durations. Today, the duration of spa therapy may be long for people with active lives. How should we determine the duration of treatment in order to minimize therapy costs and loss of labor force? Does the duration of treatment have an impact on pain, functional status, and quality of life of patients? OBJECTIVE: Our aim was to investigate the role of application time on the efficacy of spa therapy in individuals undergoing the same treatment protocol. METHODS: This was a randomized, controlled, single-blind clinical trial design. Sixty individuals were divided into two groups: 3 weeks of therapy (group 1) and 2 weeks of therapy (group 2). Pretreatment, posttreatment, and 30-day posttreatment findings were recorded using a visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Nottingham Health Profile (NHP). RESULTS: The measurements revealed significant improvement after treatment compared to those observed prior to the treatment in both groups, except for the social isolation subgroup. When the groups were compared to each other, significant improvement was observed in pain (VAS, WOMAC, NHP) in favor of group 1 at all measurement times. CONCLUSION: Our results suggest that spa therapy has positive effects on pain, physical activity, and quality of life in patients, and 15 sessions of therapy had even better effects on pain. We believe that the duration of therapy should be determined considering the efficacy of the therapy on pain as well as the functional situation and quality of life of patients regarding therapy costs.

Radon concentration in hydrogeothermal deposit and spas of Boyacá, Colombia.

Inhaled radon and its progenies induce health concern due to high activity-concentration in selected thermal spas of Boyacá region. Hydrogeothermal water sources in a high risk seismic area, are studied to determine by water bubbling method radon concentration values; their occurrence is between few hundreds and 2000 Bq dm-3. Deposits, existing in this area, reach at the surface soil gas radon concentration up to 210 kBq m-3. Maintenance workers, health tourists and visitor's possible detrimental health effects, are discussed in relation to radon balneotherapy beneficial aspects.

Evaluation and Comparison of the Effectiveness of Rehabilitation Procedures in the Area of ​Pain in the Lumbosacral Spine Performed in Sanatoria and Outpatient Conditions.

BACKGROUND: Low back pain is among the most frequent conditions of nowadays and due to its high prevalence, it is defined as a social and civilization-related disease.Today, increasingly young patients present with this condition affecting about 80% of the population. In Poland, 70% of the population complain of back pain and the prevalence rate increases with age. The treatment includes application of various procedures, both in outpatient conditions and in sanatoria. The aim of the study was to compare the effects of sanatorium treatment with those of outpatient treatment. MATERIAL AND METHODS: 240 patients with low back pain participated in the study. The sample was divided into two groups: 120 pa-tients undergoing treated in outpatient conditions and next, 120 patients undergoing sanatorium treatment. The research was based on survey in a form of a questionnaire, selected mobility tests and assessment of pain using thermal imaging camera and an algometer. RESULTS: The patients undergoing rehabilitation procedures in a sanatorium obtain improvement in terms of pain sensation (5.39 points in VAS scale) as compared with the patients undergoing rehabilitation in outpatient conditions (4.13 points in VAS scale) ; their results also indicate improvement in low back mobility (the obtained values, however, turned out statistically insignificant). Better results can be obtained by combining conventional rehabilitation with the approaches applied in sanatorium treatment, as confirmed by the assessment of each group of patients. CONCLUSIONS: 1. Rehabilitation of patients with lumbar spine pain conditions conducted in spa conditions is a more effective treat-ment method than in an outpatient clinic and should be used universally. 2. Research is indicated to determine the effect of rest in a sanatorium (the ambience) involving low back pain relief.

Association between having a hot spring water supply in the home and prevention of long-term care.

BACKGROUND AND OBJECTIVE: According to basic studies, hot spring use has positive effects on the mind and body. However, the association between habitual hot spring use and prevention of long-term care is unknown. Using long-term care insurance data for the residents of Atami City, Japan, who can choose to install hot spring water supply in their homes, this study aimed to determine the association between the installation of a hot spring water supply in the home and prevention of long-term care. METHODS: 1. STUDY DESIGN: case-control study 2. SUBJECTS: 2719 residents (754 men, 1965 women) of Atami City, Shizuoka Prefecture, Japan, who received long-term care insurance and were certified as "Needing Support" or "Needing Long-Term Care" as of March 2017. 3. Survey methods: Information on long-term care insurance certification was linked to subjects' care level dating back to their initial certification. Also, the installation (or lack thereof) of hot spring water supply in each subject's home was linked to information on Atami household water use as of March 2017. 4. Analysis methods: The age distribution of the subjects was determined. Initial care status and care status as of March 2017 were then compared for the 2194 subjects who received long-term care certification at least twice. These subjects were classified into two groups: those whose care level had not changed or had improved (no change/improvement group) and those whose care level had worsened (worsening group). Subjects were then compared by sex and initial care level in terms of hot spring installation and percentages of no change/improvement or worsening of care level; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the chi-square test. Lastly, the same analysis was performed for all subjects grouped together, and ORs and 95% CIs were calculated using the Mantel-Haenszel test. RESULTS: Hot springs were installed in the homes of 2359 subjects overall (86.8%). The no change/improvement group and the worsening group comprised 1192 and 1002 subjects, respectively. Overall, improvement or no change in care level was observed in 1050 subjects (55.2%) in the hot spring group and 142 subjects in the no hot spring group (48.5%). Sex-adjusted OR (95% CI) was 1.311 (1.025-1.677, p = 0.036), which represented a significant association. Having a hot spring water supply in the home may be associated with preventing worsening of care level. CONCLUSION: Having a hot spring water supply in the home may be associated with preventing worsening of care level.

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.

From Probiotic to Prebiotic Using Thermal Spring Water.

BACKGROUND: La Roche-Posay Thermal Spring Water (LRP-TSW) exhibits both probiotic and prebiotic properties enhancing the diversity of the skin microbiota. METHODS: A review was undertaken to explore the role of LRP-TSW as a topical probiotic and prebiotic therapy in improving the diversity of the skin microbiota and reducing dryness and pruritus in inflammatory skin diseases. RESULTS: The concentration of minerals and non-pathogenic microbes in LRP-TSW may explain its therapeutic benefit when used for inflammatory skin diseases. Clinical studies have shown that topical LRP-TSW treatment results in increases in Gram-negative bacteria with reduction of Gram-positive bacteria, and improvements in skin microbial diversity. At the same time skin condition in atopic dermatitis, psoriasis, and general dryness in otherwise healthy skin, has been shown to improve. CONCLUSIONS: Enhancement of skin microbiota diversity using topical LRP-TSW may offer a valuable option for the treatment and maintenance of inflammatory skin diseases. J Drugs Dermatol. 2018;17(6):657-662.

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RADIONUCLIDE AND MAJOR ELEMENT ANALYSIS OF THERMAL AND MINERAL WATERS IN CROATIA WITH A RELATED DOSE ASSESSMENT.

Major elements concentrations (Na, K, Ca, Mg) and the activity concentrations of 226,228Ra, 234,238U, 210Po, 210Pb, 40K and 137Cs in northern and eastern Croatian thermal and mineral waters, collected directly from springs (or wells), are presented herein with total effective doses assessed for those waters that are considered as drinking 'cures' and are available for consumption. The methods used for radionuclide determination included alpha-particle spectrometry, gas-proportional counting and gamma-ray spectrometry, while the major element composition was determined by ICP-MS. The activity concentrations of all of the radionuclides were found to be below the guidance levels set by the WHO and EC Directive, with the exception of one water sample that measured 0.26 Bq L-1 of 228Ra. The effective ingestion dose assessment for the consumption of the so-called water 'cures' during 1, 2 or 4 weeks' time period throughout 1 year was well below the recommended 0.1 mSv for drinking water.