The privatization of spa companies in Poland - An evaluation of policy assumptions and implementation.

The aim of this article is to present the course of privatization of spa companies in Poland during the period 2001-2011. We discuss assumptions of the privatization process, as well as actual implementation, having identified the process as chaotic and inconsistent with prior legal provisions. We found that in its applied form the process resulted in limitation of the therapeutic potential of spas, and reduction of the State's ability to implement health policy in a legally determined form. We also found that privatization potentially improved spa infrastructure standards and increases the tourist potential of spa resorts. We recommend that clear eligibility criteria are applied to institutions in the privatization process, as well as the provision of legal guarantees for access to spa services financed from public resources. Such guarantees should be made a public obligation, to ensure the availability of services for insured persons, and there should be an obligation to maintain a specific part of a given institution's potential for the needs of patients funded by public health insurance.

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.

[Medical support of the Armed Forces of the Russian Federation: the results of the activities and the main tasks for 2015].

Presented the directions of activity of the medical service in the past year, including improving the legal framework, the optimization of medical management software, improving combat and mobilization readiness of units of the army, the optimization of therapeutic and preventive activities, implementation of innovative technologies, increasing mobility of units and subunits, their level of equipping with modern samples of property, training of qualified personnel, intensify research and etc. Analyzed and formulated directions of development of military medicine in 2015, including improvement of combat and mobilization readiness of the management body, military and medical organizations and departments, improving the legal framework of the military health care, holding among the troops interventions for the prevention morbidity of personnel by pneumonia and meningitis, work with commanders at all levels to ensure the preservation and strengthening of health of servicemen, improving of the system of early and active detection of diseases in the military, providing a guaranteed level of care to all contingent Ministry of Defense, improving the quality and accessibility of sanatorium treatment, maintaining constant readiness of medical special forces to carry out tasks for the purpose, improvement of professional training of personnel of the medical service, providing qualitative preparation of government medical service to participate in the training of troops, implementation of unexpected problems, equipping of army medical service with modern medical equipment finishing of the construction and renovation of military medical organizations facilities, improvement of social protection of personnel and many others.

[The use of a "buffet" style meals in the system of health-resort treatment].

The authors summarized literature sources, concerning modern ideas about the role of nutritional therapy in the system of health-resort treatment. The authors also made a research on the basis of literature, concerning health-resort nutrition divided into two systems-- buffet system and special-order system. On the basis of sanatorium establishments of the Ministry of Defense authors summarized an experience of clinical nutrition in different age groups and categories of patients. On the basis of current regulatory acts were defined forms and methods of meal catering in the Russian Federation. The results of the study are a scientific supposition for substantiation of management decision-making process, which allows to increase an efficiency of health-resort treatment via nutrition therapy.

[Normative legal aspects of health-resort treatment organization for military servicemen of the Armed Forces].

Normative legal aspects of health- resort treatment organisation for military servicemen oft he Armed Forces. The authors of the article gave an analysis of the main normative documents, regulating organization of health-resort treatment in the Russian Federation and the Armed Forces, and determining selection procedure, referral to health-resort institutions, indications and contraindications to health-resort treatment. The authors defined probable ways of improvement of normative legal regulation of health-resort treatment for military servicemen.

[The necessity of new approaches to the elaboration of the projects for the sanitary (mountainous sanitary) protection districts around the therapeutic and health-promotion facilities, health resorts and their natural medical resources].

The international experience gained during the past two centuries indicates that the most efficient and rational way to ensure the protection of the territories occupied by the therapeutic and health-promotion facilities, spa centres, and health resorts together with their natural medical resources is to set up sanitary (mountainous sanitary) protection districts or zones along the perimeter of these territories. Beginning from 2000, numerous changes and amendments have been annually introduced in the Russian legislation intended to ensure efficacious control over the rational exploitation of the territories of therapeutic and health-promotion value and their natural medical resources. These initiatives have negative effect on the activities of these organizations and the quality of the services they are expected to provide. Taken together these effects lead to the degradation of the spa and health resort business. Bearing in mind the current conditions for economic activities, it is proposed, in contrast to the former global approach, to envisage in the aforementioned projects the establishment of the sanitary (mountainous sanitary) protection districts or zones and determine their borders based on the results of the assessment of their potential for the protection of therapeutic factors and other valuable resources. Equally important is the maximum reduction of the areas of the second and third zones taking into account their relevant objective characteristics. In certain cases, the protective district may coincide with the second zone. As far as the federal health resorts and large territories of special health-promotion value are concerned, some of them may have two or more sanitary (mountainous sanitary) protection districts. Both the owners and the users of these territories should be provided the necessary and sufficient possibilities for the rational nature use at the grounds and in the adjacent water areas suitable for the development of health resort business in the conditions guaranteed by the national legislation.

An overview of pool and spa regulations in Mediterranean countries with a focus on the tourist industry.

The Mediterranean area is densely populated and a very popular tourist destination. This study aimed at gathering up-to-date information on current national pool and spa regulations. We formulated and duly distributed to 20 Mediterranean countries a questionnaire divided into two sections: for pool and spa facilities, respectively. The questionnaire was formulated in such a way that a positive answer would imply that the specific topic was addressed effectively. While all 20 countries responded to the swimming-pool-related questionnaire, only 11 of these countries reported the existence of spa-related regulations. When combining the response overall of all countries for pool and spa facilities together, of a grand total of 606 answers, 183 (30.2%) were positive. The positive answers in the pool section of the questionnaire were 29% of the total of 420 answers while positive answers in the spa section of the questionnaire were fewer (27.8% of the total of 176 answers). The countries were grouped by geographical area of the Mediterranean basin where they are situated. Also, the questions were grouped into broad thematic categories. The paper presents conclusions drawn on the basis of the data received according to these geographical and thematic groupings.

["Podmoskovie"--health resort institution of the Federal Drug Control Service of the Russian Federation celebrates the 20th anniversary].

The article is dedicated to the 20th anniversary of the Federal government health resort institution of the Federal Drug Control Service of the Russian Federation (FGI "Health resort "Podmoskovie" of the Federal Drug Control Service of the Russian Federation). In this health resort were developed treatment programs for patients with abnormalities of the cardiovascular, respiratory and digestive systems; methods of ultrasonic, laser and magnetic therapy, atmospheric hypoxic, herbal medicine, speleotherapy are employed. Widely used natural healing factors of Ruza district of the Moscow region such as climate therapy, treatment with mineral water group of X type of Smolensk from own wells and balneo-mudtherapy. Over the past 20 years 70 000 patients received an appropriate treatment in this health resort.

Termalismo Social em Caldas da Imperatriz - SC: realidade e desafios / Social Thermalism Caldas da Imperatriz - SC: reality and challenges

Entende-se por Termalismo Social a complexidade da utilização das águas termominerais em saúde, pensando-se ainda em seus aspectos ecológicos, históricos, sociais e de lazer. Este artigo pretende contextualizar o Termalismo Social em Caldas da Imperatriz, localidade de Santo Amaro da Imperatriz ­ SC, quanto a seus aspectos históricos, características das águas termais e potencialidades em saúde, desafios vivenciados e possíveis soluções para a concretização do Termalismo Social no local. Para tanto, foram analisados artigos, teses, reportagens de jornais e processos judiciais disponíveis na World Wide Web, além de visitas ao local.O artigo apresenta um breve histórico do Termalismo na localidade, aborda as características físico-químicas e suas indicações terapêuticas e expõe alguns problemas existentes e, por fim, possibilidades para a consolidação do Termalismo Social em Caldas da Imperatriz são exibidas.(AU)

The term Social Thermalism is understood as the complexity of the use of thermo-mineral water in health, still thinking of its ecological, historical, social, recreational aspects. This article aims to contextualize the Social Hydrotherapy in Caldas da Imperatriz, town of Santo Amaro da Imperatriz - SC, as well as its historical aspects, characteristics of thermal waters and potential health, challenges experienced and possible solutions to the implementation of the Social Hydrotherapy. Articles, thesis, newspaper reports and court cases available on the World Wide Web were analyzed, as well as a site visit. The article presents a brief history of the Hydrotherapy in the locality, discusses the physical and chemical characteristics and their therapeutic indications, introduces some existing problems and finally, possibilities for the consolidation of Social Hydrotherapy in Caldas da Imperatriz are presented.(AU)

[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.

[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.

Evaluación de un programa de intervención en residencias geriátricas para reducir la frecuentación hospitalaria / Evaluation of an intervention program in Nursing Homes to reduce hospital attendance

Objetivos. Este estudio describe los resultados de un programa de intervención asistencial en residencias geriátricas (RG) y su repercusión en las visitas a urgencias, ingresos hospitalarios urgentes y gasto farmacéutico. Material y métodos. Intervención comunitaria no aleatorizada en RG con un grupo control. Se implanta progresivamente desde 2007 a 2009 en 10 RG (857 plazas) que participaron voluntariamente. Formaron el grupo control 14 RG (1.200 plazas), las que declinaron participar y las que no estaban asignadas a nuestros centros de salud. La intervención consistió en la valoración geriátrica integral y visitas de seguimiento por personal especializado, revisión y adecuación del tratamiento farmacológico, gestión de casos y formación del personal. Resultados. En las RG intervenidas la frecuentación a urgencias disminuyó pasando de1.165‰ (IC 95% 1.100-1.240) en 2006 a 674‰ (IC 95% 620-730) en 2009, mientras que en las no intervenidas se incrementó de 1.071‰ (IC 95% 1.020-1.130) a 1246‰ (IC 95% 1.190-1.310). Los ingresos hospitalarios urgentes se redujeron de 48,4% (IC 95% 45-52) en 2006 a 32,1% (IC 95% 29-35) en 2009, mientras que en el grupo control se incrementó de 43,5% (IC 95% 41-46) a 55,8% (IC 95% 53-59). Se redujo un 9,0% el gasto de farmacia en las RG intervenidas frente a un incremento del 11,9% en las RG control. Conclusiones. El programa de intervención ha demostrado ser efectivo para reducir la frecuentación hospitalaria y de urgencias en los pacientes institucionalizados y permite racionalizar los costes de farmacia(AU)

Objectives. This study describes the outcomes of an intervention program in Nursing Homes and their effects on emergency room attendance, hospital admissions, and pharmaceutical expenditure. Material and methods. This involved non-randomised community intervention in Nursing Homes with a control group. The program was implemented gradually from 2007 to 2009 in 10 Nursing Homes (857 beds) which participated voluntarily. The control group consisted of 14 Nursing homes (1,200 beds), which refused to participate or were not assigned to our Primary Care centres. Intervention consisted of comprehensive geriatric assessment and follow-up visits by trained personnel, review and adjustment of drug treatment, case management and staff training. Results. In the Nursing Homes where the program was carried out, emergency room attendance decreased from 1165‰ (95%CI 1100-1240]) in 2006 to 674‰ (95%CI 620-730) in 2009, while in the control group it increased from 1071 (95%CI 1020-1130) to 1246‰ (95%CI 1190-1310). The hospital admissions also decreased from 48.4% (95%CI 45-52) in 2006 to 32.1% (95%CI 29-35) in 2009, while in the control group increased from 43.5% (95%CI 41-46) to 55.8% (95%CI 53-59). There was also a 9% reduction in pharmacy cost compared with an increase of 11.9% in the control group. Conclusions. The intervention has proved effective at reducing hospital admissions and emergency room attendance in institutionalised patients, thereby streamlining pharmacy costs(AU)

Unidades de prevención de caídas y de fracturas osteoporóticas. Propuesta del Grupo de Osteoporosis, Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología / Falls and osteoporotic fractures prevention units. Proposed Osteoporosis, Falls and Fractures Group of the Spanish Society of Geriatrics and Gerontology

En el marco del Grupo de Osteoporosis, Caídas y Fracturas (GOCF) de la Sociedad Española de Geriatría y Gerontología (SEGG) se realiza una revisión de la epidemiología de las caídas, junto a la descripción de aquellas medidas que han mostrado cierto grado de efectividad en prevenirlas. También se expone la propuesta de un modelo básico común de actuación en las unidades de prevención de caídas, dirigido principalmente a la comunidad. Finalmente se presenta un modelo consensuado de registro de caídas, común a nivel de los ámbitos comunitario e institucional, con el objetivo de que sea útil y fácil de cumplimentar en cualquiera de los niveles asistenciales(AU)

Since forming the Osteoporosis, Falls and Fractures Group of the Spanish Society (GOCF) of Geriatrics and Gerontology (SEGG) a review was performed of the epidemiology of falls, along with a description of measures that have shown a degree of effectiveness in prevention. We also present the proposal of a common basic model of action in fall prevention units, mainly addressed to the community. Finally, a consensus model falls register is presented, common to community level and institutional areas, with the objective of being useful and easy to fill in at any care level(AU)

[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.

[Methodology of strategy development for the improvement of efficiency of sanatorium-resort services in the regional healthcare system].

Methodological aspects of the development of the strategy for the improvement of efficiency of sanatorium-resort services in the regional healthcare system based on the experience of "Prokopievsky" sanatorium, Kemerovo region. Different stages in the history of the sanatorium are described with special reference to its role in continuous medico-social rehabilitation of the patients and in the maintenance of continuity of medical care provided by municipal outpatient, inpatient, and sanatorium settings. Transition to new forms of organization and work of sanatorium-resort facilities required in-depth analysis of their day-by-day activities as well as problems and obstacles hindering their further development. After having overcome the crisis of 2001-2006, sanatorium "Prokopievsky" strengthened its position at the market of sanatorium-resort services not only by continuing basic activity but also by developing new lines of medical aid and attracting new categories of patients. In 2007, the share of proceeds from medical and commercial services reached 93.3% and 1.2% respectively compared with 0.12% and 1.32% in 2002.

Estudio comparativo coste-eficiencia en un dispositivo residencial para enfermos con trastorno mental severo / A comparative cost/efficiency study in a residential unit for patients with severe mental disorder

Funcionamiento de las Residencias para personas con trastorno mental severo, basado en su eficiencia y coste económico (AU)

The functioning of the residential program from Severe mental illness, based on the study of its efficiency and economic cost (AU)

Do traditional measures of water quality in swimming pools and spas correspond with beneficial oxidation reduction potential?

OBJECTIVES: Oxidation reduction potential (ORP) is a more direct measure of water quality in swimming pools and spas than free chlorine. However, ORP is not considered in some state pool codes, including Minnesota's. This study examined whether compliance with the Minnesota Pool Code assured an ORP > or = 650 millivolts (mV), a value defined in the literature as adequate to kill viral and bacterial pathogens within seconds. We also examined predictors of ORP. METHODS: Water samples from public swimming pools and spas in Hennepin County, Minnesota, were collected during routine health inspections from May through August 2004 and assessed for compliance with the state pool code. ORP values were also recorded. A Chi-square test was used to evaluate the association between code compliance and ORP. Analysis of covariance (ANCOVA) and logistic regression models were used to determine predictors of ORP. RESULTS: The study included 132 pools and 30 spas. Compliance with the Minnesota Pool Code did not assure an ORP > or = 650 mV (p < 0.01). Outdoor pools had significantly lower ORP values than indoor pools (p < 0.001). ANCOVA and logistic regression models showed that ORP decreased with increasing cyanuric acid, increasing pH, and decreasing free chlorine. CONCLUSIONS: Compliance with the Minnesota Pool Code did not coincide with adequate ORP values, particularly for outdoor pools and spas. Therefore, it may be appropriate for states to include a minimum ORP standard of > or = 650 mV in their swimming pool regulations. Doing so would likely benefit the health of swimmers.

Prevalencia de úlceras por presión en residencias geriátricas / Prevalence of bed sores in geriatrics nursing home residences

El número de residencias asistidas para ancianos ha aumentado considerablemente. No obstante, las políticas de control de calidad en dichos centros no han crecido a la misma velocidad. Se estima que el 95% de las úlceras por presión (UPP) es potencialmente evitable, por lo que su aparición se relaciona directamente con la calidad de cuidados prestados. Estudio descriptivo transversal, revisando aleatoriamente 364 historias clínicas de usuarios institucionalizados. Se recogieron variables sociodemográficas, estado cognitivo, presencia de UPP y patologías asociadas. Los datos fueron analizados mediante SPSS 13.0. La edad avanzada, sexo femenino, estado cognitivo alterado y patología invalidante son factores de riesgo de padecer UPP en residencias geriátricas. Se evidencia la necesidad de estudios específicamente diseñados para evaluar el impacto sanitario de las UPP en las residencias geriátricas(AU)

The number of nursing homes to provide the elderly with in-residence care has increased considerably. However, the quality control policies for those centers have not grown at the same speed. Estimates show that 95% of bed sores, ulcers caused by pressure, are potentially avoidable; therefore, their appearance has a direct relationship to the quality of treatment provided. This study is a transversal descriptive study which randomly reviews 364 clinical cases of institutionalized patients. The investigators gathered in socio-demographic variables, cognitive state, presence of bed sores and associated pathologies. These data were analyzed by means of SPSS 13.0. Advanced age, female gender, altered cognitive state, invalid-making pathology are risk factors to suffer bed sores in nursing homes. The investigators find evidence that it is necessary to carry out studies specifically designed to evaluate the sanitary impact of bed sores in nursing homes(AU)