Outbreaks Associated with Treated Recreational Water - United States, 2015-2019.

Outbreaks associated with treated recreational water can be caused by pathogens or chemicals in aquatic venues such as pools, hot tubs, water playgrounds, or other artificially constructed structures that are intended for recreational or therapeutic purposes. For the pseriod 2015-2019, public health officials from 36 states and the District of Columbia (DC) voluntarily reported 208 outbreaks associated with treated recreational water. Almost all (199; 96%) of the outbreaks were associated with public (nonbackyard) pools, hot tubs, or water playgrounds. These outbreaks resulted in at least 3,646 cases of illness, 286 hospitalizations, and 13 deaths. Among the 155 (75%) outbreaks with a confirmed infectious etiology, 76 (49%) were caused by Cryptosporidium (which causes cryptosporidiosis, a gastrointestinal illness) and 65 (42%) by Legionella (which causes Legionnaires' disease, a severe pneumonia, and Pontiac fever, a milder illness with flu-like symptoms). Cryptosporidium accounted for 2,492 (84%) of 2,953 cases resulting from the 155 outbreaks with a confirmed etiology. All 13 deaths occurred in persons affected by a Legionnaires' disease outbreak. Among the 208 outbreaks, 71 (34%) were associated with a hotel (i.e., hotel, motel, lodge, or inn) or a resort, and 107 (51%) started during June-August. Implementing recommendations in CDC's Model Aquatic Health Code (MAHC) (1) can help prevent outbreaks associated with treated recreational water in public aquatic venues.

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.

Intervenciones basadas en el ejercicio y el entorno para la prevención de caídas en personas con deterioro cognitivo que viven en centros de cuidado: revisión sistemática y metaanálisis / Interventions based on exercise and physical environment for preventing falls in cognitively impaired older people living in long-term care facilities: a systematic review and meta-analysis

Esta revisión evalúa la efectividad de las intervenciones que utilizan el ejercicio y/o la modificación ambiental para la prevención de caídas en ancianos institucionalizados con deterioro cognitivo. Durante julio de 2014 se consultaron las principales bases bibliográficas y recursos especializados sobre el tema. Se seleccionaron ensayos controlados aleatorizados sobre intervenciones destinadas a prevenir caídas, que incluían el ejercicio físico y/o modificaciones del entorno, aplicadas en esta población. Dos revisores valoraron independientemente la elegibilidad y la calidad metodológica de los estudios. Se agruparon los datos cuando fue adecuado. Se identificaron 14 estudios con 3.539 participantes que utilizaban el ejercicio y/o la modificación ambiental de forma única o combinada con otras intervenciones. Ambas intervenciones demostraron efectividad en la reducción del número de caídas, desde un enfoque combinado. No obstante, hacen falta más estudios para asegurar la efectividad del uso del ejercicio y del entorno para la prevención de caídas en esta población (AU)

This systematic review aims to report the effectiveness of interventions based on exercise and/or physical environment for reducing falls in cognitively impaired older adults living in long-term care facilities. In July 2014, a literature search was conducted using main databases and specialised sources. Randomised controlled trials assessing the effectiveness of fall prevention interventions, which used exercise or physical environment among elderly people with cognitive impairment living in long-term care facilities, were selected. Two independent reviewers checked the eligibility of the studies, and evaluated their methodological quality. If it was adequate, data were gathered. Fourteen studies with 3,539 participants using exercise and/or physical environment by a single or combined approach were included. The data gathered from studies that used both interventions showed a significant reduction in fall rate. Further research is needed to demonstrate the effectiveness of those interventions for preventing falls in the elderly with cognitive impairment living in long-term care establishments (AU)

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.

Health resorts as gateways for regional, standardised, sports club based exercise programmes to increase the weekly time of moderate- to vigorous-intensity physical activity: study protocol.

BACKGROUND: More than 10 % (approximately 60,000) of the adult population in Styria, a federal state in the south of Austria, is granted a residential stay in a health resort each year. The target group for these stays is the general population aged between 30 and 65 years with minor symptoms such as risk factors for cardio-metabolic diseases. Stays are financed by health insurance companies and last up to three weeks. The treatment during the stays consists of exercise and nutritional intervention as well as psychological support when needed. However, because of the absence of regional programmes linked with the residential stay, the sustainability of the interventions is questionable. METHODS/DESIGN: This prospective, controlled, multicentre, open-label study will compare two groups. Participants will be included in the study if they live in any of eight predefined Styrian regions and do not meet the minimal WHO physical activity guidelines. Those allocated to the intervention group will receive a voucher for 12 regional, standardised, sports club based exercise sessions. The members of the control group will come from different but matched Styrian regions and will receive an informative written brochure. The primary outcome will be the weekly level of health-enhancing physical activity, which will be objectively measured with an accelerometer and supplemented by an activity log book. Together with potential determinants of physical activity it will be assessed before, 10 weeks after and 12 months after the residential stay. Additionally, psychosocial determinants will be assessed by questionnaire and fitness (cardiorespiratory fitness, handgrip, balance) will be measured. In addition to the changes in measurable parameters, processes will be evaluated to learn about the facilitators and barriers of the implementation of the programme. DISCUSSION: It is known that during the residential stay, participants are receptive to new opportunities supporting health behaviour change, but that these measures are not sustained after discharge. The structured cooperation between the health sector that has to inform the participants and the sports sector that provides the wide network of standardised programmes is the strength of the study, but at the same time a challenge. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT02552134 ; date of registration: 15 September 2015).

Termas de Águas de Lindóia: uma visão contemporânea dos usuários sobre o balneário nos aspectos termal e turístico / Thermas of Águas de Lindóia: a contemporary vision of the users on the bathhouse in thermal and tourist aspects

Define-se termalismo como um procedimento natural de tratamento alternativo e ou complementar à medicina tradicional, que se utiliza das águas minerais para se atingir a cura. As estâncias termais por suas características terapêuticas e ambientais são lugares que vão de encontro à prática do termalismo, pois atende um conjunto de elementos fundamentais, como localização geográfica, rede hoteleira e balneária. Os encaminhamentos para os tratamentos termais deixaram de ser um procedimento médico para tornar-se ao longo da história um procedimento de relaxamento, descanso e de cura por demanda própria associada ao turismo. Neste sentido, o objetivo deste estudo foi conhecer o perfil das pessoas e as razões pelas quais elas procuram o balneário de Águas de Lindóia. É um estudo de caráter qualitativo e participaram da pesquisa vinte e dois usuários do balneário, sendo que os critérios de inclusão foram homens e mulheres adultos frequentadores do balneário para utilização dos recursos termais oferecidos. Realizou-se uma entrevista semiestruturada no próprio balneário, após o usuário concordar e assinar o termo de consentimento livre e esclarecido que foi aprovado pelo Comitê de Ética da Unicamp. Para a análise dos dados utilizou-se a técnica de análise de conteúdo na qual se estabeleceram quatro categorias temáticas: perfil sócio demográfico das pessoas que procuram o balneário de Águas de Lindóia como destino turístico, o uso dos tratamentos oferecidos pelo balneário e o significado das águas como recurso terapêutico. O usuário do balneário se caracteriza por ser em sua maioria do sexo feminino, com idade média de sessenta anos e aposentada que procuram nas técnicas termais o equilíbrio orgânico e mental. Constatou-se que Águas de Lindóia no transcorrer da sua história vem se constituindo em polo turístico voltado ao lazer centrado em sua localização geografia, nos recursos termais e na rede hoteleira. Observou-se a ausência de turistas mais jovens nas dependências do balneário, a partir desse panorama, percebe-se a necessidade de ampliar a divulgação dos recursos oferecidos pelo balneário e desenvolver condutas que respondam as exigências dos turistas nas diversas faixas etárias. Conclui-se que, a maioria dos participantes do estudo pratica o termalismo de bem estar que abrange a prevenção e promoção da saúde em detrimento ao uso do termalismo clássico oferecido pelo balneário no início de suas atividades, que era o uso das águas como terapia específica para determinada doença.(AU)

Thermalism is defined as a natural and alternative treatment procedure or complement to traditional medicine that is used with mineral water to achieve the cure. The spas for its therapeutic and environmental characteristics are places that meet the practice of thermalism, as it serves a number of key elements, such as geographic location, hotel chain and bathhouse. Referrals to thermal treatments are no longer a medical procedure to become throughout history a procedure for rest, relaxation and healing on their demand associated with tourism. In this sense, the objective of this study was to know the profile of the people and the reasons why they seek the Águas de Lindóia bathhouse. It is a qualitative study and participated in the survey twenty-two users of the bathhouse, and the inclusion criteria were adult men and women goers bathhouse to use thermal resources offered. We conducted a semi structured interview in the bathhouse itself, after the user agrees and signing the consent form that was approved by the Ethics Committee of UNICAMP. For data analysis we used the technique of content analysis in which it established four thematic categories: socio demographic profile of those seeking Águas de Lindóia bathhouse as a tourist destination, the use of the treatments offered by the bathhouse and the meaning of waters as a therapeutic resource. The user of the resort is characterized by being mostly female, with an average of sixty and retired seeking thermal techniques in the organic balance and mental. It was found that Águas de Lindóia the course of its history has turned into a tourist hub geared to leisure centers on its geography location, the thermal resources and hotel chain. Observed the absence of younger tourists premises of bathhouse, from this scenario we see the need to broaden the dissemination of resources offered by the bathhouse and develop behaviors that meet the needs of tourists of different ages. We conclude that the majority of study participants practicing thermalism wellness that covers prevention and health promotion over the use of classical thermalism offered by the bathhouse at the beginning of its activities, that was the use of water as a specific therapy for disease.(AU)

[Estimation of effective doses derived from radon in selected SPA centers that use geothermal waters based on the information of radon concentrations]. / Szacowanie dawek efektywnych pochodzicych od radonu w wybranych placówkach geotermalnych SPA na podstawie informacji o stezeniach radonu.

BACKGROUND: Geothermal waters contain, among other components, soluble radon gas. Alpha radioactive radon is a health hazard to humans, especially when it gets into the respiratory tract. SPA facilities that use geothermal water can be a source of an increased radiation dose to people who stay there. Based on the available literature concerning radon concentrations, we assessed exposure to radon among people - workers and visitors of Spa centers that use geothermal waters. MATERIAL AND METHODS: Radon concentrations were analyzed in 17 geothermal centers: in Greece (3 centers), Iran (5), China (4) and India (5). Doses recived by people in the SPA were estimated using the formula that 1 hour exposure to 1 Bq/m3 of radon concentration and equilibrium factor F = 0.4 corresponds to an effective dose of 3.2 nSv. RESULTS: We have found that radon levels in SPAs are from a few to several times higher than those in confined spaces, where geothermal waters are not used (e.g., residential buildings). In 82% of the analyzed SPAs, workers may receive doses above 1 mSv/year. According to the relevant Polish regulations, people receiving doses higher than 1 mSv/year are included in category B of radiation exposure and require regular dosimetric monitoring. Doses received by SPA visitors are much lower because the time of their exposure to radon released from geothermal water is rather short. CONCLUSIONS: The analysis of radon concentration in SPA facilities shows that the radiological protection of people working with geothermal waters plays an important role. It seems reasonable to include SPA workers staying close to geotermal waters into a dosimetric monitoring program.

Sexual harassment among young tourists visiting Mediterranean resorts.

Despite the known increase in substance use and risky sexual behaviors among young people during holiday periods, issues of sexual harassment (SH) and having sex against one's will (SAW) have not received adequate attention. We implemented a cross-sectional airport-based study to identify experience of SH and SAW in 6,502 British and German holidaymakers aged 16-35 years visiting tourist resorts in Southern Europe (Crete, Cyprus, Italy, Portugal, and Spain) in summer 2009. Across all participants, 8.6 % reported SH during their holiday and 1.5 % reported SAW. Women reported higher levels of SH than heterosexual males. However, gay and bisexual males reported SH levels similar to females and the highest levels of SAW. Of 19 predictor variables tested, ten were independently associated with SH. SH was increased in those who were visitors to Mallorca or Crete, British, younger, female, gay or bisexual, frequently drunk on holiday, cocaine users, and attracted to bars where people get drunk, or where there are opportunities for sex. Among 13 predictor variables tested for SAW, four were significant. SAW reduced in those visiting Cyprus, and was strongly associated with being a gay or bisexual male, using cannabis on holiday and being attracted to bars where there were opportunities for sex. Holiday resorts represent a key location for SH and SAW, especially for holidaymakers who get drunk and use drugs. Preventive programs can raise awareness of the risks of unwanted sexual encounters on holiday and work with the tourist industry and tourist authorities to develop environments where sexual aggression is not tolerated.

[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.

Frequency of consumption of products with varying energy value by patients of a sanatorium in Ciechocinek.

The aim of the study was to assess the frequency of consumption of selected groups of foodstuffs with varying energy value by patients of the "Dom Zdrojowy" sanatorium in Ciechocinek (Poland). The survey included 100 persons, out of which 80% were obese individuals (OB), while the others were patients with cardiovascular diseases (CVD). Products with lowered energy value, especially cottage cheese, milk, "light" yogurt, as well as tea and coffee without sugar were on average consumed rather frequently. Obese patients, from among women constituted 80%, paid attention to fat content in their daily diet.

Estimation of the real population and its impact on the utilisation of healthcare services in Mediterranean resort regions: an ecological study.

BACKGROUND: The demographic structure has a significant influence on the use of healthcare services, as does the size of the population denominators. Very few studies have been published on methods for estimating the real population such as tourist resorts. The lack of information about these problems means there is a corresponding lack of information about the behaviour of populational denominators (the floating population or tourist load) and the effect of this on the use of healthcare services. The objectives of the study were: a) To determine the Municipal Solid Waste (MSW) ratio, per person per day, among populations of known size; b) to estimate, by means of this ratio, the real population in an area where tourist numbers are very significant; and c) to determine the impact on the utilisation of hospital emergency healthcare services of the registered population, in comparison to the non-resident population, in two areas where tourist numbers are very significant. METHODS: An ecological study design was employed. We analysed the Healthcare Districts of the Costa del Sol and the island of Menorca. Both are Spanish territories in the Mediterranean region. RESULTS: In the two areas analysed, the correlation coefficient between the MSW ratio and admissions to hospital emergency departments exceeded 0.9, with p < 0.001. On the basis of MSW generation ratios, obtained for a control zone and also measured in neighbouring countries, we estimated the real population. For the summer months, when tourist activity is greatest and demand for emergency healthcare at hospitals is highest, this value was found to be double that of the registered population. CONCLUSION: The MSW indicator, which is both ecological and indirect, can be used to estimate the real population in areas where population levels vary significantly during the year. This parameter is of interest in planning and dimensioning the provision of healthcare services.

Measuring the outcome of health resort programs.

OBJECTIVE: To evaluate the metric properties and practicability of valid, internationally available outcome instruments in the special setting of health resort programs. METHODS: A cohort study in a convenience sample of patients with low back pain, upper back pain, conditions of the lower extremities, and conditions of the upper extremities was conducted. Their functioning and health were assessed before and after a health resort program by the disease-specific North American Spine Society (NASS) instruments Lumbar NASS and Cervical NASS; WOMAC Osteoarthritis Index; Disabilities of Arm, Shoulder and Hand Questionnaire; and the general instrument, Medical Outcome Study Short Form-36 (SF-36). RESULTS: Completeness on the scale level ranged between 1% and 10%. Criterion validity of condition-specific instruments was confirmed by stronger associations of the pain and function scales to the Physical Health component of the SF-36 (r = -0.59 to -0.79, p < 0.001 for all scales) than to the Mental Health component (r = -0.11, NS, to r = -0.42, p < 0.001). Reliability (Cronbach's alpha coefficient) was higher than 0.8 for all scales of condition-specific instruments and for 6 of 8 SF-36 scales. Floor and ceiling effects ranged between 0% and 7%. The condition-specific instruments demonstrated a good responsiveness with an effect size ranging between 0.28 and 0.55 and with a standardized response mean between 0.32 and 0.94. The responsiveness of most SF-36 scales was similar, but the Physical Function scale showed a lower responsiveness than the condition-specific scales. CONCLUSION: The evaluated instruments can be recommended for use in clinical trials that assess the outcome of health resort programs.

[Utilization of the health care system due to somatoform complaints -- results of a representative survey]. / Inanspruchname des Gesundheitssystems wegen somatoformer Beschwerden--Ergebnisse einer bevölkerungsrepräsentativen Befragung.

OBJECTIVES: Utilization of the health care system is not determined by the presence of an organic illness, but by a multitude of interacting factors. This applies particularly to somatoform complaints and disorders, in the context of which the health care system is used very intensively and inadequately in relation to the disorder. The present paper summarizes the frequency of somatoform complaints in the general population and health care utilization due to these complaints. METHODS: On the basis of a survey carried out in 2002 for a representative population of 2089 persons (aged 14 to 92 years), the prevalence of somatoform complaints during a period of 2 years was determined. In this survey, physical complaints were defined as being somatoform when they seriously affected the person's well-being but exhibited a disparity between objective diagnostic findings and subjective experience. The psychosocial aspects were also determined. When somatoform complaints were identified, the specific utilization of the healthcare system for them was investigated. RESULTS: Somatoform complaints are very frequent in Germany: 8.3% of the population claim to suffer from clinically relevant somatoform disorders that fully meet the criteria mentioned above. The health care system is used heavily for these complaints. Within the last two years, each test person suffering from somatoform disorders consulted a physician a mean 18 times and was incapable of working for a mean of 20 days. 16% of these persons were hospitalized, 9 % received treatment at a health resort, 9 % retired, etc. DISCUSSION: The considerable utilization of health care services is an essential element of somatoform pathology and has immense medico-political relevance. The most important prerequisite for handling the 'commitment to health care system' symptom is thorough training of all physicians in the basics of somato-psycho-social medicine. This will be an important measure for cost reduction in the health care system.

[Ways of optimizing the work of tuberculosis sanatoriums for children and adolescents].

The activities of two federal and regional tuberculosis sanatoriums for children and adolescents were analyzed. The clinical characteristics and the results of the examination and treatment were studied in 510 patients aged 12-17 years who had various manifestations of tuberculous infection. The beds in the sanatoriums were ascertained to occupy irrationally: the proportion of patients with local forms of tuberculosis there is not more than 30%. Guidelines for selection of children and adolescents with tuberculosis from risk groups and for detection of the disease were developed. A proposal was made to set up consultative and diagnostic centers at the sanatorium basis. The paper shows it possible and expedient to treat children and adolescents with new-onset local, non-destructive forms of tuberculosis under the conditions of a sanatorium.

Sexual risk behavior of men who have sex with men: comparison of behavior at home and at a gay resort.

This study compared sexual behavior of gay and bisexual men (N = 551) while at their primary residence to their behavior while vacationing at a gay resort community. Participants reported behavior for the days they spent in the resort and for their last 60 days in their home residences. Overall, 11 times more non-main partners were reported for unprotected anal intercourse (UAI) per day while in the resort as for the "at home" period. Regression analysis identified negative attitudes toward condoms, less concern about AIDS, and daily number of non-main, male partners at home with whom UAI occurred as significant predictors of the daily number of non-main male partners with whom holidaymakers engaged in UAI while in the resort area. The results suggest that sexual risk taking by men who have sex with men (MSM) while on holiday may be elevated over that at home and that prevention efforts need to be promoted in gay resorts. Behavioral surveillance research would be helpful in better characterizing the current social contexts of sexual risk taking by MSM. Theory-based studies of the nature of risk-taking and sexual decision-making on "gay holiday" could inform the development of empirically proven and conceptually grounded interventions.

Multiple radon survey in spa of Loutra Edipsou (Greece).

Various investigators are involved with radon research in Greece. Numerous measurements have been reported for different regions around the country. In this study we focus on the city of Loutra Edipsou, a spa centre of about 4000 inhabitants in the northern part of the island of Evia (Greece). This city is built on an area of high geothermal activity, a fact that served as a guide to our study. The aim was to estimate the dose delivered to inhabitants, the potential alpha energy exposure of bathers and spa personnel and to investigate the radon background in this area. The detectors used were of active type. Measurements are reported for dwellings, which were grouped into two different sets: one representing typical summer periods (July and August 2002) and the other typical winter periods (October and November 2002) The Potential Alpha Energy Exposure (PAEE) of the bathers during treatment lies in the range between (45 +/- 3) and (110 +/- 5) mWLM (1 WLM = 12.97 J s m(-3)). The PAEE of the working personnel lies in the range between (34 +/- 3) and (100 +/- 20) mWLM.