Health resort medicine in non-musculoskeletal disorders: is there evidence of its effectiveness?

[Natural mineral waters of the «Seregovo» sanatorium of the Komi Republic]

Improvement of sanatorium-resort treatment system is among the priority tasks of healthcare. Balneotherapeutic methods occupy one of the first places in terms of the effectiveness of treatment of many diseases, that is especially relevant for the population living in harsh natural climatic conditions of the North.

OBJECTIVE

To assess the physiological action of natural mineral waters of the «Seregovo» sanatorium of the Komi Republic.

MATERIAL AND METHODS

An analysis of publications from databases of electronic sources (WOS, Scopus, PubMed, eLibrary) over the last 20 years, in which the results of mineral waters application are presented, was performed. The results of the study of composition and quality of mineral waters of the «Seregovo» sanatorium of the Komi Republic are presented (conclusion of the National Medical Research Center for Rehabilitation and Balneology (NMRC RB) and materials obtained by Institute of Geology of the Komi Scientific Center of the Ural branch of the Russian Academy of Sciences).

RESULTS

Distribution and diversity of mineral waters of the territory of the «Seregovo» sanatorium of the Komi Republic are presented. Mineral water from the 1K well refers to the subcategory of brines (over 35.0 g/dm3 but not more than 150.0 g/dm3), is of sodium-chloride composition (Cl- 100, Na++K+79 mg eq.%), with total mineralization of M100.9 g/dm3, with pH equal 6.22, with conditioned content of bromine and boron according to the balneological conclusion №7-1372 from 24.05.2022 by the NMRC RB of the Ministry of Health of Russia. Physiological and therapeutic effects of sodium chloride mineral waters have been shown according to the literature.

CONCLUSION

The diversity of natural mineral waters and dynamic change of their composition over time require periodic controlled study of their impact on human body. Evaluation of available literature data can serve as a basis for clarification of indications and contraindications to balneotherapy, that contributes to improvement of the effectiveness of sanatorium-resort treatment in health care centers of the Komi Republic.

How Effective Is Drinking Natural Mineral Water against Heartburn from Functional Dyspepsia, Gastroesophageal Reflux Disease, or Other Causes? A Systematic Review of Clinical Intervention Studies

BACKGROUND

For centuries, spring and other natural waters have been recommended as external or internal remedies for numerous diseases. For studies that examined the effects of drinking mineral waters against heartburn, gastroesophageal reflux disease (GERD), or functional dyspepsia, a systematic review is lacking.

OBJECTIVES

The main aim of this systematic review was to examine the effects of drinking natural mineral waters on heartburn from various causes by identifying all published intervention studies and critically appraising their methods as well as summarizing their results.

METHODS

We systematically searched the largest medical literature database MEDLINE, further relevant web sources, and gray literature for randomized and nonrandomized trials, with or without control groups, up to September 2021 and no language restrictions. Further inclusion criteria were adult patients with heartburn, drinking cure with natural mineral water as the intervention, compared to no or other interventions (care-as-usual, waiting list). We defined the reduction of heartburn symptoms and duration of disease episodes as primary and quality of life as secondary outcomes. Two reviewers independently carried out the study quality assessments (risk of bias) using the National Institutes of Health-Study Quality Assessment Tools.

RESULTS

Nine trials comprising 393 patients from Italy, Russia, Ukraine, and Germany fulfilled all inclusion criteria. We identified three randomized controlled trials (all with poor methodological quality), plus six before-after (pre/post) intervention studies without a control group. The intervention groups of the three comparative trials seemed to show a stronger reduction of self-reported heartburn symptoms, and duration of heartburn episodes than the respective control groups; however, they all had poor methodological quality.

CONCLUSION

Based on the best available evidence of clinical studies, we cannot recommend or advise against drinking natural mineral waters as a treatment for heartburn. The potential benefits of natural mineral waters that were reported in some studies with a lower evidence level (e.g., lacking a control group) should be verified by good quality randomized clinical trials with adequate comparison groups and longer follow-up periods.

Hintergrund

Seit Jahrhunderten werden Quell- und andere natürliche Wässer als äußerliche oder innerliche Heilmittel für zahlreiche Krankheiten empfohlen. Für Studien, die die Wirkung des Trinkens von Mineralwasser gegen Sodbrennen, gastroösophageale Refluxkrankheit (GERD) oder funktionelle Dyspepsie untersuchten, fehlt eine systematische Übersicht.

Zielsetzung

Das Hauptziel dieser systematischen Übersichtsarbeit war es, die Auswirkungen von Trinkkuren mit natürlichen Mineralwässern auf Sodbrennen verschiedener Ursachen zu untersuchen, indem alle veröffentlichten Interventionsstudien identifiziert und ihre Methoden kritisch bewertet sowie ihre Ergebnisse zusammengefasst wurden.

Methoden

Wir durchsuchten systematisch die größte medizinische Literaturdatenbank MEDLINE, weitere relevante Internetquellen und graue Literatur nach randomisierten und nicht-randomisierten Studien, mit oder ohne Kontrollgruppen, bis September 2021 und ohne sprachliche Einschränkungen. Weitere Einschlusskriterien waren erwachsene Patienten mit Sodbrennen, Trinkkur mit natürlichem Mineralwasser als Intervention, im Vergleich zu keiner oder anderen Interventionen (care-as-usual, Warteliste). Wir definierten die Abnahme der Symptome des Sodbrennens und die Dauer der Krankheitsepisoden als primäre und die Lebensqualität als sekundäre Endpunkte. Zwei Gutachter bewerteten unabhängig voneinander die Qualität der Studien (Verzerrungsrisiko) anhand der National Institutes of Health-Study Quality Assessment Tools.

Ergebnisse

Neun Studien mit 393 Patienten aus Italien, Russland, der Ukraine und Deutschland erfüllten alle Einschlusskriterien. Wir identifizierten drei randomisierte kontrollierte Studien (alle mit schlechter methodischer Qualität) sowie sechs Vorher-Nachher-Studien (Prä-/Post-Studien) ohne Kontrollgruppe. Die Interventionsgruppen der drei randomisierten Vergleichsstudien schienen eine stärkere Verringerung der selbstberichteten Symptome und der Dauer der Episoden des Sodbrennens zu zeigen als die jeweiligen Kontrollgruppen, allerdings waren sie alle von schlechter methodischer Qualität.

Schlussfolgerung

Auf der Grundlage der besten verfügbaren Belege aus klinischen Studien können wir das Trinken natürlicher Mineralwässer zur Behandlung von Sodbrennen weder empfehlen noch davon abraten. Die potenziellen Vorteile natürlicher Mineralwässer, die in einigen Studien mit geringerer Evidenz (z. B. ohne Kontrollgruppe) berichtet wurden, sollten durch qualitativ hochwertige randomisierte klinische Studien mit angemessenen Vergleichsgruppen und längeren Nachbeobachtungszeiträumen überprüft werden.

Arsenic in drinking water and kidney cancer: a systematic review

OBJECT

Arsenic as a chemical is found in rock, soil, air and used in various industries and their products, such as colors, hairs, and fertilizers. Humans may be exposed to arsenic mainly through food and drinking water. Due to its adverse health effects, its presence in drinking water has become a public health concern.

METHODS

In this systematic review, we investigated the relationship between arsenic concentration in drinking water and the risk of kidney cancer in humans. For this reason, various electronic databases were searched from 1992 February to November 2021. In this review, three ecological studies, two case-control studies, and four cohort studies were investigated.

RESULTS

High levels of arsenic (100 μg/L) have been reported in many countries such as southwest Taiwan, Niigata, Argentine, and northern Chile. A significant relationship was observed between kidney cancer incidence and its mortality rate with high arsenic levels in drinking water.

CONCLUSIONS

Despite the limitations in some previous studies, reviewing and comparing the data of different regions indicates a scientific relationship between kidney cancer incidence and high concentrations of arsenic in drinking water.

Geochemistry and therapeutic properties of Caucasian mineral waters: a review

The Caucasian mineral water (CMW) region is a unique area where mineral waters differ by their chemical composition and balneological properties. The presence of a wide range of mineral waters with various ions and gas components and different genesis and their therapeutic properties in the restricted area is explained by complicated geological and tectonic settings. The dominant type of mineral water in the CMW region is CO₂-bearing water with H₂SiO₃ and H₃BO₃ as the specific components. According to ion composition, gas phases' content into groundwater, total dissolved solids, and balneological characteristics, we would distinguish 9 groups and 16 types of these mineral waters, with each water type being of particular therapeutic interest. The CMW region includes four spa cities with a different therapeutic profile: Zheleznovodsk, Kislovodsk, Pyatigorsk, and Essentuki. Spa treatment is based on the use of different types of mineral waters, therapeutic muds within the region's diverse landscapes, and climatic conditions. Mineral waters are utilized in the form of baths, swimming pools, showers, various irrigations, inhalation, as well as drinking therapy. Therapeutic mineral waters are used to treat gastrointestinal problems, metabolic and nervous system disorders, as well as various diseases of liver, kidney, urinary tract, circulatory system, respiratory organs, and skin.

YouTube as a source of information for water treatments

The purpose of the study was to investigate the quality and reliability of YouTube videos as a source of information in water treatments. We searched videos on YouTube ( www.youtube.com ) using the following keywords: "health resort medicine," "spa treatment," "spa therapy," "hydrotherapy," "thermal medicine," "balneology," and "balneotherapy" on June 17th, 2021. The global quality scale (GQS) was used to evaluate the quality of the videos. The assessment of reliability was evaluated using the modified DISCERN tool. Some other video parameters and sources of the videos were also recorded. One hundred twenty-one (121) videos were analyzed. The most common video source was advertisement (46.3%). GQS and modified DISCERN median scores were generally low. They were superior for "hydrotherapy" and "balneotherapy" and were also higher in videos uploaded by health-related persons or organizations (physicians, health-related professionals, and health-related websites). A statistically significant positive correlation was found between investigated parameters (like view ratio, number of likes, video power index, video length) and GQS. Only video length was correlated with modified DISCERN for investigated parameters. The median video power index scores were statistically higher for "spa therapy" and "spa treatment." The YouTube content linked with water treatments has poor quality and reliability most of time. The hydrotherapy and balneotherapy keywords have the best quality and reliability.We think that designers of water treatment videos should involve health professionals more often so that the content of their video will better explain the details of medical conditions or interventions.The scientific experts should ensure a consensus in terminology to straighten the awareness of water treatments for patients and physicians.

Clinical efficacy of medical hydrology: an umbrella review

The aim of this research was to summarize available scientific evidence on the efficacy of medical hydrology for the management of any health condition. The search was conducted on 26th March 2021, in the following databases: Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, and Google Scholar. All relevant literature reviews investigating the clinical efficacy of interventions characterized by the use of natural mineral waters and muds were included. The quality of studies was assessed with the "AMSTAR 2" tool. After article screening, 49 reviews were included in this work. Overall, retrieved scientific evidence suggests that spa therapy is beneficial for patients affected by some specific musculoskeletal conditions, with improvements potentially lasting up to 9 months. Moreover, balneotherapy can be an integrative support for the management of chronic venous insufficiency and some inflammatory skin diseases like psoriasis. The role of spa therapy in rehabilitation appears relevant as well. More limited, although interesting evidence exists for inhalation and hydropinic therapies. Globally, retrieved evidence suggests that, besides individual wellbeing, medical hydrology can be useful for public health. In particular, higher-quality studies seem to support the integrative use of spa-related interventions for conditions like osteoarthritis, fibromyalgia, low back pain of rheumatic origin, and chronic venous insufficiency. However, the body of evidence has some limitations and further clinical trials should be designed for each relevant application to consolidate and expand acquired knowledge.

Morphological and Immunohistochemical Features of the Heart under the Effect of Hydrogen Sulfide Balneotherapy

The effects of hydrogen sulfide baths and sulfide-silt mud applications on the abdominal wall were studied in outbred white rats. Heart preparations stained with hematoxylin and eosin were analyzed and the mean numbers of cells expressing Ki-67, Nkx-2.5, and mesenchymal stem cell markers were determined. Hydrogen sulfide balneotherapy promoted the development of blood capillaries in rat hearts and an increased the expression of CD34. A decrease in the regenerative potential of the myocardium was found due to a decrease in the content of proliferating cells and cells expressing CD73, CD90, and CD105, and also due to the absence of cells stained for cardiomyogenic differentiation marker Nkx-2.5.

Effects of Sodium Chloride-Rich Mineral Water on Intestinal Epithelium. Experimental Study

Since knowledge concerning the cellular and tissue substrate that explains the therapeutic action of mineral waters is generally very scarce, we address the different effects that Lanjarón-Capuchina mineral water exerts on the intestinal epithelium in an experimental model as a prototype of the sodium chloride-rich mineral waters used in digestive disorders. In the experimental protocol, two groups of five adult Wistar rats received unrestricted mineral water in their diet or mineral water directly into the gastrointestinal tract through a catheter. A third control group was given a standard diet and water ad libitum. Intestinal samples for scanning electron microscopy were analyzed according to standardized methods. The observations carried out by microscope after the administration of the sodium chloride-rich mineral water clearly indicate that the hypertonic action of this mineral water affects the structure of the intestinal epithelium. It modifies the microvilli absorption in terms of the groups of enterocytes and the secretion of goblet cells, but it particularly affects the epithelial renewal process, accelerating and stimulating cell extrusion. The type of extrusion mechanism observed by microscope allows us to affirm that, although this increased after direct administration, it does not generate an epithelial disruption as it occurs in other circumstances with other extrusion modalities.

Evaluation of the Use of Sterilized and Non-Sterilized Peruibe Black Mud in Patients with Knee Osteoarthritis

This study aimed to evaluate the effects of treatment with Peruíbe Black Mud (PBM) on the clinical parameters and quality of life of patients with knee osteoarthritis and to compare the effects of PBM samples simply matured in seawater and PBM sterilized by gamma radiation. A controlled, double-blind trial was conducted with 41 patients divided into two treatment groups composed of 20 and 21 patients: one group was treated with matured PBM and the other with sterilized PBM. Evaluations were done using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Medical Outcomes Study Short Form 36 (SF-36) questionnaires, the Kellgren and Lawrence (KL) radiographic scale, and the quantification of the serum levels of inflammatory biomarkers. An improvement in pain, physical functions, and quality of life was observed in all of the patients who underwent treatment with both simply matured and sterilized PBM. Nine patients showed remission in the KL radiographic scale, but no statistically significant differences were observed in the serum levels of inflammatory mediators before or after treatment. Peruíbe Black Mud proves to be a useful tool as an adjuvant treatment for knee osteoarthritis (OA), as shown by the results of the WOMAC and SF-36 questionnaires and by the remission of the radiographic grade of some patients on the Kellgren and Lawrence scale.

PATHOPHYSIOLOGICAL MECHANISMS OF BALNEOTHERAPY WITH POTENTIAL IMPLICATIONS FOR CENTRAL ASIAN SPAS AND SANATORIUMS

Spa therapy includes all modalities/ treatments based on evidence that are administered in spas or sanatoriums. Balneotherapy, the immersion in mineral water, is the main balneological modality in spa therapy programs. Clinical trials performed in Europe, Turkey, and Israel have shown clinical benefits of spa therapy/ balneotherapy in several diseases mainly pertaining to rheumatic and musculoskeletal diseases and dermatological diseases as well. However, mechanisms by which balneotherapy may improve the clinical symptoms of patients have been less evaluated/ documented in the literature. Although the literature on mechanisms of action of balneotherapy has still been evolving and accumulating, some evidence from preliminary studies paves the way for generating a hypothesis that balneotherapy has an influence on physiological mechanisms, immune system, inflammation, and oxidative stress. Extrapolation of the evidence-based clinical practice and scientific experience of Europe, Turkey, and Israel to Central Asian spas and sanatoriums is although possible; future studies investigating clinical efficacy, safety profile, and possible mechanisms of action of balneotherapy of regional spas are needed to better understand the role of balneotherapy and whether it has any local differences.

Spa therapy and burn scar treatment: a systematic review of the literature

Spa therapy is an integral part of the treatment of burn scars. The objective of this systematic review is to provide an overview of the spa therapy used in the treatment of burn scars and analyze its effects reported in clinical studies. We used the PRISMA checklist and queried 8 scientific databases from August 2019 to July 2020 for articles referenced with the specific key words: (burn) AND ((spa) OR (crenotherap*) OR (sulfur bath) OR (balneo*) OR (hydrotherap*) OR (mineral water) OR (thermal water) OR (spring water) OR (health resort medicine)). We used the EPHPP-QAT to assess the quality of the studies. Out of 10,050 publications identified in our database searches, 3 studies were selected: 2 clinical trials and 1 descriptive multicenter study that polled surgeons for their opinion on spa therapy for burn patients. All of the articles concluded that spa therapy is positive in burn scar recovery. No strong study on the effectiveness of spa therapy for burn scars care according to the EPHPP-QAT was identified. Spa therapy in the Saint Gervais spa center appears to be the only spa technique to have been evaluated for burn scar care. This review underscores the need to perform clinical studies to evaluate the effects and benefits of spa therapy for burn scars on patient's quality of life, and improve our understanding of the mechanisms of action of physiotherapy. Care programs should be harmonized in order to conduct multicenter studies.

Evaluation of the Feasibility of a Two-Week Course of Aquatic Therapy and Thalassotherapy in a Mild Post-Stroke Population

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are nowadays used. Water-based exercise may improve the physical conditions and quality of life of people in the post-stroke phase. The objective of this study is to test whether aquatic therapy in an enriched environment at the seaside (a thalassotherapy center) could play a role in this condition. A quasi-experimental prospective study consisting of a specific program assessed 62 patients with a mild–moderate disability pre- and post-2 weeks of intensive treatment. They followed a thalassotherapy regimen including aquatic therapy in a sea water pool at 32–34 °C for 45 min daily five times a week. The outcomes measured were the Berg Balance scale, the Timed Up and Go test, the 10-meter walking test, the 6-min walking test, the Pain Visual Analogue Scale, the WHO Well-being index, EuroQoL VAS and EuroQoL 5D. We observed a significant improvement in all outcomes measured (p < 0.001, except mobility EuroQoL p < 0.05), except in the other four dimensions of the EuroQoL 5D and 10-metre walking test (NS). Conclusion: A two-week intensive course of aquatic therapy and thalassotherapy may be beneficial in the short term by reducing pain and improving the functional status and overall well-being of post-stroke patients.

[Effekte der Kneipp-Therapie: Ein systematischer Review der aktuellen wissenschaftlichen Erkenntnisse (2000-2019)]

Einleitung: Ziel dieser systematischen Übersicht war die Bewertung der verfügbaren Evidenz zur Wirkung der Kneipp-Therapie. Methoden: MEDLINE, Embase, Web of Science, Cochrane-Library und CAMbase wurden nach relevanten Artikeln, veröffentlicht zwischen 2000 und 2019, durchsucht. Graue Literatur wurde über Google Scholar und andere Tools bezogen. Studien mit jeglicher Art von Studiendesign, die die Effekte der Kneipp-Therapie untersuchten, wurden eingeschlossen. Die Qualitätsbewertung erfolgte mittels EPHPP-QAT. Ergebnisse: 25 Quellen, darunter 14 kontrol-lierte Studien, wurden eingeschlossen. Gemäß EPHPP-QAT wurden 3 Studien "stark", 13 "moderat" und 9 "schwach" bewertet. Neun (64%) der kontrollierten Studien berichteten signifikante Verbesserungen nach Kneipp-Therapie im Gruppenvergleich bei chronisch-venöser Insuffizienz, Hypertonie, leichter Herzinsuffizienz, menopausalen Be-schwerden und Schlafstörungen in verschiedenen Patientenkollektiven sowie verbesserte Immunparameter bei gesunden Probanden. Im Hinblick auf Depression und Angst bei Mammakarzinom-Patientinnen mit klimakterischen Beschwerden, Lebensqualität bei Post-Polio-Syndrom, krankheitsbedingten polyneuropathischen Beschwerden und Inzidenz von Erkältungsepisoden bei Kindern konnten keine signifikanten Gruppenunterschiede festgestellt werden. Elf unkontrollierte Studien berichteten Verbesse-rungen bei allergischen Symptomen, Dyspepsie, Lebens-qualität, Herzratenvariabilität, Infekten, Hypertonie, Wohlbefinden, Schmerz und polyneuropathischen Beschwerden. Diskussion/Schlussfolgerung: Die Kneipp-Therapie scheint bei zahlreichen Beschwerdebildern in verschiedenen Patientenkollektiven positive Effekte zu bewirken. Zukünftige Studien sollten noch stärker auf eine methodisch sorgfältige Studienplanung achten (Kontrollgruppen, Randomisierung, adäquate Fallzahlen, Verblindung), um Verzerrungen entgegenzuwirken.

INTRODUCTION

The aim of this systematic review was to evaluate the available evidence on the effect of Kneipp therapy.

METHODS

MEDLINE, Embase, Web of Science, Cochrane Library and CAMbase were searched for relevant articles published between 2000 and 2019. Grey literature was obtained through Google Scholar and other tools. Studies with any kind of study design that examined the effects of Kneipp therapy were included. The quality assessment was carried out using EPHPP-QAT.

RESULTS

25 sources, including 14 controlled studies, were included. According to EPHPP-QAT, 3 studies were rated as “strong,” 13 as “moderate” and 9 as “weak.” Nine (64%) of the controlled studies reported significant improvements after Kneipp therapy in a between-group comparison in chronic venous insufficiency, hypertension, mild heart failure, menopausal complaints, and sleep disorders in different patient collectives as well as improved immune parameters in healthy subjects. Regarding depression and anxiety in breast cancer patients with climacteric complaints, quality of life in post-polio syndrome, disease-related polyneuropathic complaints and incidence of cold episodes in children, no significant group differences were found. Eleven uncontrolled studies reported improvements in allergic symptoms, dyspepsia, quality of life, heart rate variability, infections, hypertension, well-being, pain and polyneuropathic complaints.

DISCUSSION/CONCLUSION

Kneipp therapy seems to be beneficial for numerous symptoms in different patient groups. Future studies should pay even more attention to methodologically careful study planning (control groups, randomisation, adequate case numbers, blinding) to counteract bias.

Short- and long-term beneficial effects of medicinal mineral water administration

Medicinal mineral water, being provided by recognized immunosuppressive properties, results useful for treating many pathological conditions. A well-known source of sulfurous and oligomer medicinal mineral waters is located in Caramanico Terme (Pescara, Italy). Caramanico Terme is a small town in the Majella's National Park, and its precious and peculiar environment offers a medicinal mineral water (also known as cures or crenotherapy), that since 1576 is administrated to a large number of patients (around 15,000 per year). However, no scientific conclusions on the efficacy of Caramanico's Terme medicinal mineral water properties are available. Therefore, we have carried out an epidemiological study, enrolling a population of 370 subjects that have received crenotherapy. Such a population has been also compared to a control group of individuals (untreated, N = 287), never undergone any medicinal mineral water administration. Detailing the geomorphological characteristics of Caramanico Terme environment, we have also analyzed the results of the study that showed that pathology-relapses, as well as related manifestations of symptoms and drug employments, were largely reduced after one or more cycles of crenotherapy. On the other hand, a sub-group of subjects receiving crenotherapy for more than 5 years (N = 166) presented a highly reduced prevalence of a large spectrum of pathologies (cardiovascular, inflammatory, neurological and cancer diseases), with respect to an overlapping population (in terms of age and genders) of untreated subjects. We have also clarified the role of aging and long-term effects of medicinal mineral-water administration. Altogether, these data indicated that the clinical employment of Caramanico's Terme medicinal mineral water produces short- as well as long-term beneficial effects, both with respect to the amelioration of life quality of patients and in reducing the probability to develop major disabling pathologies (i.e., cardiovascular, cancer and neurological diseases). Therefore, these data will open novel strategies for a larger application of crenotherapy.

Evaluation of antioxidant status and oxidative stress markers in thermal sulfurous springs residents

Sulfurous springs have been traditionally used in medical treatment for different purposes. These beneficial effects of sulfurous water have been attributed to the presence of sulfurous compounds mainly in the form of hydrogen sulfide (H₂S). The purpose of the present study is to explore the effects of long-term exposure to sulfurous springs on oxidative stress and antioxidant biomarkers responses in individuals who lived nearby the sulfurous springs. The studied area was Al- Hammah sulfurous springs, which is located in the northern part of the Jordan Rift Valley and host many sulfurous springs. Residents in sulfurous springs area are continuously exposed to water and gases emission more than the overall population. We have found that the sulphate levels were 7 times higher in sulfurous springs water samples than control water samples. The majority of the volunteers involved in the present study were more than ten years long residence and lived in range distance between one to five kilometers (less than 3 miles) away from main sulfurous spring, and visited the sulfurous spring at least once a month. We did not find any noticeable symptoms in sulfur spring residents such as headaches, nausea, breathing problems. The total oxidative stress (TOS) and oxidative stress index (OSI) in sulfurous spring residents were lower than control individuals. The total antioxidant capacity (TAC) and total nitric oxide (NO_X) levels were higher in sulfurous spring residents compared to control group. Furthermore, we have highlighted that living nearby the sulfurous springs does not affect oxygen saturation levels (SPO₂) or heart pulse rate . These findings suggest that long-term exposure to sulfurous springs boost the antioxidant capacity and reduce oxidative stress levels in the human body. Hence, visiting sulfurous springs can act as natural remedies to diminish oxidative stress as they show promising potential in several-oxidative stress-related diseases treatment.

Geothermal water for health state improvement: randomised controlled study

Abstract Introduction. Aim: to evaluate the effect of geothermal water of different mineralization on health state improvement. Material and method. A randomized controlled single blinded parallel groups interventional study was performed. 250 participants were divided into 5 groups: 3 balneotherapy (20, 40 and 60 g/l total mineralization), 1 tap water, and 1 control group. Hydrotherapy was carried out on an outpatient on everyday basis for 5 days a week over a 2-week period. The main effect on health state was measured using SHSQ-25 questionnaire after 2 weeks and each month during 3-month follow-up period. Examination by a physician and common blood and urine tests were done after the treatment period. Results and discussions. After a 2-week treatment, participants receiving all types of hydrotherapy showed a significant therapeutic response compared to the control group, especially in fatigue and mental state subcategories. The biggest total health enhancing effect after therapy was in seen in 40 g/l group, followed by 20 g/l group. The smallest effect was seen in tap water group. The most significant post-therapy effect during 3 months was given by 40 g/l procedures. Health self-rating after 2 weeks improved significantly only in geothermal water groups and lasted 2-3-month post-treatment. 2 weeks of balneotherapy had significant impact on Er, MCV, MCH, MPV, Eo, Tr, urine SG, and pH. According to the physician’s assessment, the best results after 2 weeks were in 20 g/l group, but 40 and 60 g/l water procedures gave more residual effect. Conclusions. The geothermal water of 40 g/l total mineralization has the best positive effect for health enhancement after 2 weeks and during 3-month period. 20 g/l water gives fast and short- term health effect, while 40-60 g/l water has long-lasting effect on health status. Key words: health status, balneotherapy, geothermal water, hydrotherapy,

Introduction of a web portal for an Individual Health Management and observational health data sciences

Background

There is a global trend to a stronger active involvement of persons in the maintenance and restoring of health. The Competence Centre for Complementary Medicine and Naturopathy (CoCoNat) of the Technical University of Munich (TUM) has developed a lifestyle concept to enable each individual to manage his or her health – Individual Health Management (IHM) – and a web-based health portal named Virtual Tool for Education, Reporting, Information and Outcomes (VITERIO^®), which addresses these needs for practice and research.

Objectives

The objectives of this study were to establish a core set of questionnaires for a self-assessment program on certain risk indications and comprehensive protection factors of health and to develop and enhance 1) tools for individual feedback, longitudinal self-monitoring, self-assessment, and (self-)care-planning; 2) training packages; 3) open notes and records for provider and patient; and 4) tools for monitoring groups and single participants in various indicators for individual coaching and scientific evaluation.

Methods

The CoCoNat of TUM, Faculty for Applied Health Science of Technische Hochschule Deggendorf, VITERIO^® company, IHM campus network, and Erich Rothenfußer Foundation, Munich, provide a consortium responsible for content, research strategy, technical production and implication, postgraduate education for IHM coaches, implementation of IHM in various settings, and funding resources.

Results

A data set of indicators for health screening and self-monitoring of findings, symptoms, health behavior, and attitudes are integrated into a web-based health portal named VITERIO^®. The article introduces some implemented graphical solutions of developed tools and gives examples for daily use.

Conclusion

Behavioral change and adaptation in attitudes and personal values are difficult issues of health education and lifestyle medicine. To address this problem best, the implementation of a patient-centric, performance measures-based program including open records and a blended learning concept were elaborated. The combination of an individual web-based health portal with personal coaching allows the implementation of IHM in everyday practice.

Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review

Balneotherapy and spa therapy are well-known practices, even though limited evidence has been produced about their biological effects. This systematic review primarily aims at assessing if balneotherapy, mud/peloid therapy, and spa therapy may influence cortisol levels. Secondarily, it aims at understanding if these interventions may improve stress resilience. PubMed/Medline, Embase, and Cochrane Library were searched for relevant articles in English or Italian about studies involving healthy and sub-healthy subjects or patients with a diagnosed disease about effects of balneotherapy, mud/peloid therapy, and spa therapy on serum and salivary cortisol levels. Fifteen studies involving 684 subjects were included. Five studies investigated biological effects of balneotherapy alone. Two of them reported significant changes of cortisol levels in healthy participants. The other three studies reported no significant variations in patients with rheumatic conditions. No studies investigated biological effects of mud/peloid therapy alone. Ten studies investigated biological effects of spa therapy with or without included mud/peloid therapy, and in all but two studies, significant variations of cortisol levels were reported. Our main findings suggest that balneotherapy may have the potential to influence cortisol levels in healthy subjects, in such a way as to improve stress resilience. Spa therapy with or without included mud/peloid therapy demonstrated the same potential to influence cortisol levels also in sub-healthy subjects and in patients with a diagnosed disease. Therefore, balneotherapy and spa therapy may be considered as useful interventions for the management of stress conditions. Further investigation is needed because of limited available data.

Effects of single moor baths on physiological stress response and psychological state: a pilot study

Moor mud applications in the form of packs and baths are widely used therapeutically as part of balneotherapy. They are commonly given as therapy for musculoskeletal disorders, with their thermo-physical effects being furthest studied. Moor baths are one of the key therapeutic elements in our recently developed and evaluated 3-week prevention program for subjects with high stress level and increased risk of developing a burnout syndrome. An embedded pilot study add-on to this core project was carried out to assess the relaxing effect of a single moor bath. During the prevention program, 78 participants received a total of seven moor applications, each consisting of a moor bath (42 °C, 20 min, given between 02:30 and 05:20 p.m.) followed by resting period (20 min). Before and after the first moor application in week 1, and the penultimate moor application in week 3, salivary cortisol was collected, blood pressure and heart rate were measured, and mood state (Multidimensional Mood State Questionnaire) was assessed. A Friedman test of differences among repeated measures was conducted. Post hoc analyses were performed using the Wilcoxon signed-rank test. A significant decrease in salivary cortisol concentration was seen between pre- and post-moor bath in week 1 (Z = -3.355, p = 0.0008). A non-significant decrease was seen between pre- and post-moor bath in week 3. Mood state improved significantly after both moor baths. This pilot study has provided initial evidence on the stress-relieving effects of single moor baths, which can be a sensible and recommendable therapeutic element of multimodal stress-reducing prevention programs. The full potential of moor baths still needs to be validated. A randomized controlled trial should be conducted comparing this balneo-therapeutic approach against other types of stress reduction interventions.

Sulphurous Mineral Waters: New Applications for Health

Sulphurous mineral waters have been traditionally used in medical hydrology as treatment for skin, respiratory, and musculoskeletal disorders. However, driven by recent intense research efforts, topical treatments are starting to show benefits for pulmonary hypertension, arterial hypertension, atherosclerosis, ischemia-reperfusion injury, heart failure, peptic ulcer, and acute and chronic inflammatory diseases. The beneficial effects of sulphurous mineral waters, sulphurous mud, or peloids made from sulphurous mineral water have been attributed to the presence of sulphur mainly in the form of hydrogen sulphide. This form is largely available in conditions of low pH when oxygen concentrations are also low. In the organism, small amounts of hydrogen sulphide are produced by some cells where they have numerous biological signalling functions. While high levels of hydrogen sulphide are extremely toxic, enzymes in the body are capable of detoxifying it by oxidation to harmless sulphate. Hence, low levels of hydrogen sulphide may be tolerated indefinitely. In this paper, we review the chemistry and actions of hydrogen sulphide in sulphurous mineral waters and its natural role in body physiology. This is followed by an update of available data on the impacts of exogenous hydrogen sulphide on the skin and internal cells and organs including new therapeutic possibilities of sulphurous mineral waters and their peloids.

Stress and Fatigue Management Using Balneotherapy in a Short-Time Randomized Controlled Trial

Objective. To investigate the influence of high-salinity geothermal mineral water on stress and fatigue. Method. 180 seamen were randomized into three groups: geothermal (65), music (50), and control (65). The geothermal group was administered 108 g/L salinity geothermal water bath for 2 weeks five times a week. Primary outcome was effect on stress and fatigue. Secondary outcomes were the effect on cognitive function, mood, and pain. Results. The improvements after balneotherapy were a reduction in the number and intensity of stress-related symptoms, a reduction in pain and general, physical, and mental fatigue, and an improvement in stress-related symptoms management, mood, activation, motivation, and cognitive functions with effect size from 0.8 to 2.3. In the music therapy group, there were significant positive changes in the number of stress symptoms, intensity, mood, pain, and activity with the effect size of 0.4 to 1.1. The researchers did not observe any significant positive changes in the control group. The comparison between the groups showed that balneotherapy was superior to music therapy and no treatment group. Conclusions. Balneotherapy is beneficial for stress and fatigue reduction in comparison with music or no therapy group. Geothermal water baths have a potential as an efficient approach to diminish stress caused by working or living conditions.

Health effects of natural spring waters: A protocol for systematic reviews with a regional case example

BACKGROUND

Spring water therapies have been used since at least 1550 BC. Despite the growing body of evidence supporting these therapies for a range of conditions, including musculoskeletal, dermatological, respiratory and cardiovascular conditions, they do not currently form part of mainstream healthcare in many countries. The protocol established in this paper aims to support systematic reviews that examine the health outcomes associated with human exposure to regional spring waters, using the Australia and New Zealand context as a case study.

METHODS/DESIGN

The protocol searches for studies in eight health/medical databases, searches three local health/medical journals, and includes forwards and backwards searching. Standard systematic review methods are used including: specifying pre-determined inclusion criteria and data management plans, appraising the studies for bias, and allocation to a hierarchy of evidence.

DISCUSSION

The protocol supports a review and comprehensive synthesis of the current evidence regarding the health effects of natural spring water, and can be adapted for reviews in other regions. From this evidence, recommendations regarding practice and future research can be made on the therapeutic role of spring water.