Advances in modern Balneology: new evidence-based indications from recent studies.

Balneotherapy (BT) is a therapeutic approach that utilizes various forms of water-based treatments to promote health and well-being. BT possesses a rich historical heritage and has garnered recognition from esteemed institutions such as the World Health Organization (WHO). Recent scientific research enables the identification of relevant diseases (obesity, metabolic diseases, sleep disorders, mental health conditions, Long-COVID-19, and cancer rehabilitation) that could potentially benefit from balneo-therapeutic treatments, thereby presenting new avenues of opportunity for SPA ("Salus per Aquam") medicine. These conditions exemplify the potential benefits of BT for ailments beyond the traditional scope of treatment associated with BT (most commonly osteoarthritis, fibromyalgia, rheumatic back pain, and chronic inflammatory respiratory or skin disorders). Overall, the current scientific evidence suggests that BT holds significant potential for enhancing both individual wellbeing and public health. However, further high-quality clinical trials are essential to corroborate these preliminary findings and to provide critical insights into the therapeutic benefits of BT, paving the way for its broader integration into healthcare practices and public health initiatives.

Biophysical effects of a natural peloid on normal skin.

A protocol study was designed to examine cutaneous behavior after continuous application of a peloid in the dry mineral residue of Lanjarón-Capuchina natural mineral water. This study aims to analyze the biomechanical behavior of normal skin using various non-invasive bioengineering techniques after the application of this peloid. We determine the effects of its application for 3 months on 38 healthy volunteers (41.4 ± 5.9 years, range 32-58) without a previous history of skin diseases by courtmetry, sebumetry, pH-metry, reviscometry, and tewametry. It was shown that the production of cutaneous sebum is significantly reduced by 6%, trans epidermal skin loss (TEWL) by 21%, skin fatigue by 30%, elasticity increased by 19%, firmness by 5%, and a skin redensification by 6% was obtained under these experimental conditions. Disparate and non-significant results were obtained concerning pH and viscoelasticity. Continuous skin care with the Lanjarón-Capuchina natural peloid modifies skin behavior, normalizing sebaceous secretion, favoring the biomechanical properties of the skin and the skin barrier function without modifying skin homeostasis.

Balneotherapy for osteoarthritis: a systematic review.

This systematic review is aimed to evaluate the effects of balneotherapy with thermal mineral water for managing the symptoms and signs of osteoarthritis located at any anatomical site. The systematic review was conducted according to the PRISMA Statement. The following databases were consulted: PubMed, Scopus, Web of Science, Cochrane Library, DOAJ and PEDro. We included clinical trials evaluating the effects of balneotherapy as a treatment for patients with osteoarthritis, published in English and Italian language, led on human subjects. The protocol was registered in PROSPERO. Overall, 17 studies have been included in the review. All of these studies were performed on adults or elderly patients suffering from osteoarthritis localized to knees, hips, hands or lumbar spine. The treatment assessed was always the balneotherapy with thermal mineral water. The outcomes evaluated were pain, palpation/pressure sensibility, articular tenderness, functional ability, quality of life, mobility, deambulation, ability to climb stairs, medical objective and patients' subjective evaluation, superoxide dismutase enzyme activity, serum levels of interleukin-2 receptors. The results of all the included studies agree and demonstrated an improvement of all the symptoms and signs investigated. In particular, pain and quality of life were the main symptoms evaluated and both improved after the treatment with thermal water in all the studies included in the review. These effects can be attributed to physical and chemical-physical properties of thermal mineral water used. However, the quality of many studies resulted not so high due and, consequently, it is necessary to perform new clinical trial in this field using more correct methods for conducting the study and for processing statistical data.

Trends in spa and balneology in postcovid era, outcomes, and perspectives.

The COVID-19 pandemic has dramatically affected spa and balneology not only in the Czech Republic. Generally, almost two years without spa patients and clients led to a dramatic outflow of labor. The article main purpose is to analyze pandemic impact on the structure of spa patients and clients, to identify main current spa problems to be overcome, and to summarize possible future trends in modern spa and balneology for current and future spa clients. Spa will remain an important medical solution for treatment of some diagnoses using healing mineral-medical waters and natural sources, but they must innovate their services and treating programs to answer current questions and clients 'demands. It will be a complex patient care combining body and mental treatment and care with the use of so-called therapeutic landscape, a unique landscape surrounding spa towns and places, as well as wellness aspects. Modern spa must be an integral part of health care systems in Europe.

[Current approaches to medical-psychological rehabilitation of military personnel of the Russian Federation Armed Forces. (Literature review)]. / Sovremennye podkhody k mediko-psikhologicheskoi reabilitatsii voennosluzhashchikh Vooruzhennykh sil Rossiiskoi Federatsii. (Obzor literatury).

Improving the medical and psychological rehabilitation system is a priority area for restoring the military personnel's working capacity and combat capabilities after fulfilling special tasks. Changes in the psychoemotional state due to significant psychic and emotional tension can cause mental impairments, which has negative impact not only on military personnel themselves, but also on their combat working capacity. The article presents an overview of forms and methods of medical and medical-psychological rehabilitation used in sanatorium-resort organizations of the Ministry of Defence of the Russian Federation.

[Tumnin mineral spring. History of development]. / Tumninskii mineral'nyi istochnik. Istoriya osvoeniya.

The article dwells upon the history of the discovery of the Tumnin mineral spring, the establishment and development of the Far Eastern health resort «Goryachy Klyuch,¼ located in the basin of Chope creek, a tributary of the largest river in the eastern macroslope of Sikhote Alin, Tumnin river, located 25 km from the Strait of Tartary. A historical sketch since the first mentioning of the Tumnin mineral spring from 1903 to the present day, as well as the results of hydrogeological expeditions to determine the chemical composition and α-activity of Tumnin mineral water at different periods, are presented. A contribution of a geological expedition that established a large deep-lying tectonic structure permeable to upwelling thermal water flows is described. The role of the staff of the physiotherapy and balneology department of the Khabarovsk Medical Institute in the study of the mechanism of action and clinical effectiveness of the Tumnin mineral water is addressed. A balneological characteristic of nitric and siliceous thermal water, the basic therapeutic factor of «Goryachy Klyuch¼ health resort, which has always been popular among the Far East residents, but gained special importance and appreciation of patients during the pandemic of new coronavirus infection, is given. Currently, in the health resort «Goryachy Klyuch¼, patients with skin diseases, musculoskeletal, gynecologic, neurologic diseases, digestive tract disorders, metabolic conditions, upper airways, cardiovascular disorders, occupational diseases are treated using balneotherapy and other methods of non-drug therapy. At present, the health resort «Goryachy Klyuch¼ is going through a difficult but interesting period of improvement of recreation opportunities for the Far East residents.

[National Medical Research Center of Rehabilitation and Balneology, Ministry of Health: 100 years of history for the benefit of the health resort industry development in the country]. / FGBU «NMITs reabilitatsii i kurortologii¼ Minzdrava Rossii: 100 let istorii vo blago razvitiya sanatorno-kurortnoi otrasli strany.

In 2021, the National Medical Research Center of Rehabilitation and Balneology celebrates its centenary. The article highlights the main historical stages of the formation of the Center, which is intended to be the leading scientific institution in the country in the field of balneology, the main directions of experimental and clinical research of the Center's employees and significant scientific achievements.

Balneotherapy for musculoskeletal pain: does the mineral content matter?

Musculoskeletal pain is a health challenge with various treatment strategies. The study has been accomplished with the aim to reveal the effect of mineral water with different mineral content on musculoskeletal pain and related symptoms experienced. A randomized controlled single-blinded parallel-group study has been performed (145 participants with pain; 5 groups). The duration of treatment was 2 weeks, whereas follow-up has taken 3 months. Change in pain after a single procedure and the pain parameters with related symptoms during the study period have been measured. The effect size using Cohen's d has been estimated. Small effect (0.2-0.4) on pain has been distinguished after each mineral water procedure. Tap water procedures have been effective in 60% of cases. Twenty grams per liter water baths have had a small effect on pain intensity and tender points, body flexibility, and spinal mobility, and a medium one on sleep quality, and reduced CRP. Forty grams per liter water has had a small effect on pain intensity, frequency, and spinal mobility, and a medium one on flexibility, fatigue, and sleep quality, and reduced ESR. Sixty grams per liter water has had a small effect on pain parameters and fatigue, and a medium one on flexibility and sleep quality, and reduced ESR. The effect lasting up to 2 months has been identified mostly in the 60 g/L group. Tap water has had a short time effect on pain intensity and tender points. There have not been any changes of sufficient significance identified in the control group and any differences between mineral water groups. Sufficient difference between mineral and tap water groups has been determined in pain intensity, spinal mobility, and sleep quality, whereas in the case of the control group, significant difference in pain intensity and frequency, flexibility, and spinal mobility has been identified. The consumption of pain medication has significantly decreased in all mineral water groups. The total mineral content of the water has no significant influence on the reduction of musculoskeletal pain. Mineral water baths have small effect on pain and medium effect on other musculoskeletal disease-related symptoms and pain medication consumption lasting up to 3 months; it is more beneficial than tap water or no treatment for the improvement of symptoms associated with musculoskeletal diseases. Even single balneotherapy procedure results in small pain reduction.

Effects of drinking natural hydrogen sulfide (H2S) waters: a systematic review of in vivo animal studies.

Natural waters containing originally hydrogen sulfide (H2S) gas with an S2-level at least 1 mg/L are classified as "sulfur waters" or "hydrogen sulfide waters." This systematic review aimed to evaluate in vivo experimental studies investigating the biological effects of natural H2S water drinking in healthy or with disease model laboratory animals. A comprehensive databases search (PubMed, Embase, Web of Science, and Google Scholar) was performed and PICOS criteria were used to assess eligibility. All relevant studies were identified, screened, and examined. The qualitative assessment was performed with the help of the SYRCLE Risk of Bias tool. A total of nine articles were included. The extracted data showed that ad libitum drinking of such waters by rats and mice exert beneficial effects on animal model of diabetes and glucose metabolism plus protective effects on diabetic cardiac, testicular, and nephrological complications as shown biochemically, histopathologically, and bio-molecularly. Additional effects were gastroprotection, antioxidant effects and improvement of intestinal physiology in healthy animals, reduction in general signs of murine model of colitis in mice, improvement in lipid metabolism and lipid-lowering effect, and positive interference with the enterohepatic cycle of the bile acids and biliary functions in hyperlipidemic rats. This systematic review provides preliminary insights into the "biological truth" about natural H2S waters and partly elucidates their potential therapeutic role in balneology and health resort medicine. However, it should be kept in mind that the retrieved preclinical data cannot be directly extrapolated to humans. Additionally, most of the included studies were rated for unclear risk of bias across all categories except random allocation, reflecting very poor reporting of methodological details. These limitations should be addressed when planning similar studies in the future. The question "can traditional hydropinic therapies or drinking cures with H2S waters at natural sulfur water spas/health resorts or natural (even artificial) H2S water consumption at home exert similar effects in humans?" remains to be clarified by clinical trials.

In vitro evaluation of potential benefits of a silica-rich thermal water (Monfortinho Thermal Water) in hyperkeratotic skin conditions.

Thermal therapy has gained popularity over the years, and Portugal is one of the richest European countries in mineral therapeutic waters. The interest in the use of these natural mineral waters (NMW) for dermatologic purposes is continuously growing but there is a lack of scientific studies supporting its health benefits. The study aims to investigate the effect of a silica-rich NMW in skin cell homeostasis using two representative cell lines of the epidermis and dermis, keratinocytes and fibroblasts, respectively, in addition to a macrophage cell line. Mouse skin fibroblasts, macrophages and human keratinocytes were exposed to culture medium prepared with NMW. Cell metabolism (MTT or resazurin assays) and cell proliferation (trypan blue exclusion dye assay) were investigated. Migration (scratch-wound assay) and senescence (ß-galactosidase activity assay) of fibroblasts were also studied. Exposure to NMW compromised the cell metabolic state of all the cell lines tested. This impairment was more pronounced in skin keratinocytes (60% reduction) relatively to skin fibroblasts (45% reduction) or macrophages (25% reduction). Proliferation of macrophages was reduced threefold upon exposure to thermal water, compared to controls. No differences were observed in migration between fibroblasts exposed to NMW and controls, while a potentiation of senescence of these cells was observed. Our results shed light in the bioactive effects of a silica-rich NMW supporting its therapeutic use. A reduction in both cell metabolism and proliferation of keratinocytes and macrophages supports the empirical clinical benefits of this NMW in hyperkeratotic conditions, such as psoriasis and atopic dermatitis.

[Kolyma health resort «Talaya¼ (to its 80th birthday)]. / Kolymskaya zdravnitsa «Talaya¼. K 80-letiyu.

The article is devoted to the history of the creation and establishment of the Far Eastern resort «Talaya¼, located in the Far North of Russia, in the Magadan Region among the hills of the Kolyma Range, in the valley of the Talaya River. A historical essay is presented from 1868 to the present days, including periods of the resort's development at various stages of Russia's formation (pre-revolutionary, post-revolutionary periods, the era of developed socialism, present times). The contribution of resort doctors, geologists, employees of research institutes to the study of the mechanism of action and clinical effectiveness of the use of Tal mineral water is described. The balneological characteristic of nitrogen-siliceous thermal water, the main therapeutic factor of the Talaya resort, is given. Currently, the Talaya sanatorium is providing the treatment of patients with diseases of the skin, musculoskeletal system, gynecological, neurological diseases, diseases of the digestive system, metabolism, upper respiratory tract, cardiovascular system, occupational diseases using balneotherapy, mud therapy and others methods of non-drug therapy. Hundreds of thousands of northerners were healed by the Kolyma health resort, which gained fame as the «Northern Pearl¼. Today, during the reorganization of health care, the Talaya sanatorium is going through a difficult but interesting period in improving the possibilities of healing the inhabitants of the northern regions of Russia.

[To the 100th anniversary of the founding of the Pyatigorsk research institute of balneology]. / K 100-letiyu so dnya osnovaniya Pyatigorskogo nauchno-issledovatel'skogo instituta kurortologii.

The article is dedicated to the 100th anniversary of the Pyatigorsk state research Institute of balneology. It presents the main stages of formation and development, scientific achievements of the Institute and highlights the main activities at the present stage.

[Prospects for the development of the sanatorium-and-spa industry of the Russian Federation]. / Perspektivy razvitiya sanatorno-kurortnoi otrasli Rossiiskoi Federatsii.

THE PURPOSE OF THIS WORK: Is to analyze the current state of the sanatorium-and-spa complex of the Russian Federation and to develop promising ways of its development. MATERIAL AND METHODS: The state analysis was carried out on the basis of the results of field events, including the assessment of the quality of medical care; video conference call results; data from the State Register of the Resort Fund of the Russian Federation; reports on medical rehabilitation for people with disabilities and children with disabilities in medical and sanatorium-and-spa organizations. When assessing, an integral indicator of the current state of the medical industry was used, based on which the total integral indicator of the sanatorium-and-spa complex was calculated. RESULTS: Based on the analysis, a rating of the constituent entities of the Russian Federation was compiled depending on the state of the sanatorium-and-spa treatment, the problems of the industry and ways to solve them were highlighted. The development paths of the sanatorium-and-spa complex of the Russian Federation are substantiated, which are reflected in the Development Strategy of the sanatorium-and-spa complex of the Russian Federation, approved by order of the Government of the Russian Federation dated November 26, 2018 №2581-r. CONCLUSION: The implementation of the proposed measures will restore the world-recognized achievements of domestic balneology and increase the effectiveness and accessibility of sanatorium-and-spa treatment, as well as achieve the targets specified in the Development Strategy of the spa complex of the Russian Federation.

To treat or not to treat? Misbeliefs in spa water disinfection.

"Spa waters should be left untreated" says the dogmatic approach. Health authorities of European countries having traditional spa culture strictly control hygienic conditions of bathing in thermal/mineral waters. These regulations are based on the assumption that chemical treatment (disinfection) of such waters impacts their healing effects. However, a slow change of paradigm has been observed in studying the mode of action of spa waters that could help overcome recent attitudes. Organic content or the role of microbiome has also been emphasized by some authors recently. The article deals with possible interactions among aquatic microorganisms and the disinfection and health effects of spa waters and tries to explain the new findings in this field.

Efficacy of baths with mineral-medicinal water in patients with fibromyalgia: a randomized clinical trial.

The layout of this study, designed as a randomized crossover clinical trial, is to evaluate the efficacy of an intervention with mineral-medicinal water from As Burgas (Ourense) in patients suffering from fibromyalgia. This sample was randomly divided into two groups: group A and group B. In phase 1, group A had 14 baths in thermal water for a month and standard pharmacological treatment; group B, standard pharmacological treatment. Washout period is 3 months. In phase 2, group A had standard treatment and group B had 14 baths in thermal water for a month plus standard treatment. The Fibromyalgia Impact Questionnaire (FIQ) was used; this grades the impact of the illness from 1 (minimum) to 10 (maximum), which was measured in both phases. Twenty-five patients were included in each group and the study was concluded with 20 patients in group A and 20 in group B. The intervention group obtained, once the baths finished, a mean score of 60.3 (± 11.8) and the control group of 70.8 (± 13.0) (p < 0.001). Three months later, the intervention group presented a mean score of 64.4 (± 10.6) and the control group of 5.0 (± 11.3) (p < 0.001). We can therefore conclude that the simple baths with mineral-medicinal water from As Burgas can make an improvement on the impact caused by fibromyalgia.

Head-out immersion in natural thermal mineral water for the management of hypertension: a review of randomized controlled trials.

Hypertension is a major public health problem in the world, and the management of hypertension has always been a research of interest. Balneotherapy, with its recreational aspect, is more acceptable than medication intake and lifestyle change for the management of hypertension. The aim of this review was to summarize the current available data on the clinical effects of head-out immersion in natural thermal mineral water (HINTMW) as the most common method of balneotherapy used in the management of hypertension. We screened the PubMed, EMBASE, Cochrane Library, China Science and Technology Journal, China National Knowledge Infrastructure, WANFANG, and China Biology Medicine disc databases and selected 12 randomized controlled trials involving a total of 1122 participants. Among 12 trials, HINTMW was taken as the only intervention in only one study, HINTMW was taken in addition to basic antihypertensive drugs in three studies, and HINTMW was taken in combination with advice to follow nonpharmacological methods in one study involving participants who partly used antihypertensive drugs, while HINTMW combined with other interventions, such as natural convalescent factor therapy, psychotherapy, exercises, nutrition therapy, and integrated care, was taken in addition to basic antihypertensive drugs in the other 7 studies. Our results showed that natural thermal mineral water immersion alone or natural thermal mineral water immersion as an adjuvant therapy to medication or natural thermal mineral water immersion combined with other interventions had no adverse effects on hypertensive patients, and most even had positive effects. However, more high-quality evidences on therapeutic effectiveness of natural thermal mineral water immersion on hypertension are needed from additional randomized controlled trials with high methodological quality.

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.

[Balneological resource of the 'Zharkie Vody' (Hot Waters) spring (Iturup Island)]. / Bal'neologicheskii resurs istochnika 'Zharkie vody' (o. Iturup).

BACKGROUND: It is necessary to develop a balneotherapeutic and tourist-recreational complex on Iturup Island (hereinafter referred to as Iturup Island). This investigation was conducted in the framework of the federal target program 'Socioeconomic development of the Kuril Islands, Sakhalin Region, for 2007-2015' under No. 478 dated 08.09.06. OBJECTIVE: To characterize the balneological resource of the 'Zharkie Vody' (Hot Water) spring on Iturup Island. MATERIAL AND METHODS: Expeditionary studies were conducted at the 'Zharkie Vody' spring located near the village of Raidovo (Iturup Island): its water samples were taken and chemically analyzed in a certified laboratory in Khabarovsk; the biological activity of the mineral water was studied using the Cyto-Expert portable non-invasive diagnostic equipment adapted to the expeditionary conditions. RESULTS: The mineral water from the 'Zharkie Vody' deposit (Iturup Island) is weakly mineralized siliceous sulfate-bicarbonate-chloride calcium-sodium thermal and has an activation function on living cell structures. CONCLUSION: The data obtained from the studies created the prerequisites for setting up a balneotherapy complex near the 'Zharkie Vody' on Iturup Island and provide optimistic forecasts for the further study of this deposit.

[Evgeny Fyodorovich Levitsky is a physician, organizer, and scientist (On the occasion of the 75th anniversary of his birthday)]. / Levitskii Evgenii Fedorovich - vrach, organizator, uchenyi (k 75-letiiu so dnia rozhdeniia).

The paper presents the creative biography of Professor E.F. Levitsky, a famous Russian scientist, Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Director (1990-2009), Principal Researcher, Tomsk Research Institute of Balneology and Physiotherapy, Federal Biomedical Agency of Russia; Head, Department of Rehabilitation Medicine, Physiotherapy and Balneology, Faculty for Advanced Training and Professional Retraining of Specialists, Siberian State Medical University (Tomsk) (1995-2012). It reflects the main trends of scientific and social activities of the scientist.

[The importance of therapeutic muds of the Arasan-Kundyzdy deposit for the development of peloid therapy in Kazakhstan]. / Znachenie lechebnykh griazei mestorozhdeniia Arasan-Kundyzdy dlia razvitiia peloidoterapii v Kazakhstane.

BACKGROUND: To provide the population with inexpensive and effective medical products of domestic production is one of the most important public health tasks. These may include therapeutic muds, the high therapeutic value of which is confirmed by many years of positive experience with peloid therapy. The basis for interest in therapeutic muds is their efficiency in treating many diseases and regularly discovered new opportunities for their use. OBJECTIVE: To strive to streamline the use of previously discovered therapeutic muds in Kazakhstan, to search for new hydromineral resources, and to register the latter as minerals. MATERIAL AND METHODS: The material was the results of the analysis of published data on studies of therapeutic muds, their use for medicinal purposes in sanatorium and extrasanatorium conditions, which had been prepared during the grant financing project 'Development of an innovative procedure for the qualitative and quantitative assessment of therapeutic muds in Southeastern Kazakhstan as hydromineral raw materials' (IRN AR 05130934) in 2018. RESULTS AND CONCLUSION: The paper provides a brief description of the results of the study of therapeutic mud deposits in Western Kazakhstan, North Kazakhstan, and the Almaty Region. It gives the main list of diseases in which the use of mud therapy is effective.