Improvements on Glycation by Thermal Effects of Balneotherapy ─Ａ Pilot Study─ / 日本温泉気候物理医学会雑誌

  Objective: We investigated the effects of 5 days of spa therapy on the glycation reaction and oxidative balance defense system.  Subjects: The subjects were divided into a glucose spikes group (S group: 5 cases) and non-glucose spike group (non-S group: 6 cases), and a comparative study was conducted.  Method: The subjects stayed at the Inubosaki Onsen “Superb View Inubosaki Hotel” for 5 days and took spa baths twice a day for 20 min (balneotherapy). Before and after the baths, the degree of glycation was measured. Erythrocyte deformation by dark field microscope was classified into stages between 0 and 5, and the state of deformation and the levels of advanced glycation end products (AGEs) were measured. In addition, the oxidative stress (reactive oxygen metabolites, d-ROM), antioxidant power (biological antioxidant potential, BAP), and latent antioxidant capacity (BAP/d-ROM ratio) were also measured.  Result: The red blood cell images before balneotherapy were worse in the S group, but there was no significant difference in the AGE values. There was also no significant difference between the two groups in terms of the oxidative balance defense system. A comparison before and after balneotherapy showed that the red blood cell images significantly improved from 3 (3-3) (median (IQR)) to 2 (1-2)°in the S group. Oxidative stress also significantly improved in group S from 342 (334-362) to 314 (303-345) CARR U. In the non-S group, the AGE value improved significantly from 0.52 (0.48-0.59) to 0.5 (0.43-053) a.u. There were no significant differences in the other items.  Discussion: Changes in red blood cell images are considered to reflect changes in the early reactions of glycation, and AGEs may be evaluated as representing whole early and late reactions of glycation. In the S group, the early reaction improved, and in the non-S group, the entire glycative reaction was effective. Although the each mechanism of blood glucose to different, balneotherapy was shown to be effective in improving glycation.

Improvements on Glycation by Thermal Effects of Balneotherapy—Ａ Pilot Study— / 日本温泉気候物理医学会雑誌

Objective: We investigated the effects of 5 days of spa therapy on the glycation reaction and oxidative balance defense system.  Subjects: The subjects were divided into a glucose spikes group (S group: 5 cases) and non-glucose spike group (non-S group: 6 cases), and a comparative study was conducted.  Method: The subjects stayed at the Inubosaki Onsen “Superb View Inubosaki Hotel” for 5 days and took spa baths twice a day for 20 min (balneotherapy). Before and after the baths, the degree of glycation was measured. Erythrocyte deformation by dark field microscope was classified into stages between 0 and 5, and the state of deformation and the levels of advanced glycation end products (AGEs) were measured. In addition, the oxidative stress (reactive oxygen metabolites, d-ROM), antioxidant power (biological antioxidant potential, BAP), and latent antioxidant capacity (BAP/d-ROM ratio) were also measured.  Result: The red blood cell images before balneotherapy were worse in the S group, but there was no significant difference in the AGE values. There was also no significant difference between the two groups in terms of the oxidative balance defense system. A comparison before and after balneotherapy showed that the red blood cell images significantly improved from 3 (3-3) (median (IQR)) to 2 (1-2)° in the S group. Oxidative stress also significantly improved in group S from 342 (334-362) to 314 (303-345) CARR U. In the non-S group, the AGE value improved significantly from 0.52 (0.48-0.59) to 0.5 (0.43-053) a.u. There were no significant differences in the other items.  Discussion: Changes in red blood cell images are considered to reflect changes in the early reactions of glycation, and AGEs may be evaluated as representing whole early and late reactions of glycation. In the S group, the early reaction improved, and in the non-S group, the entire glycative reaction was effective. Although the each mechanism of blood glucose to different, balneotherapy was shown to be effective in improving glycation.

IL-10 Cytokine as Potential Biomarkers in Women with Fibromyalgia Who Underwent to a Short Balneotherapy Treatment

Abstract Fibromyalgia (FM) is a nonarticular rheumatic syndrome that leads to diffuse myalgia, sleep disturbances and morning stiffness. Balneotherapy has been shown an effective strategy to improve the health conditions of patients; however, the treatment follow-up is based on patient report due to the lack of biomarkers. Thus, this study evaluated the application of cytokines and phosphoglycerate mutase I (PGAM-I) to monitoring FM patient underwent to balneotherapy treatment. Eleven healthy and eleven women with FM were submitted to daily sessions of balneotherapy during 10 days. Clinical and quality of life parameters were assessed through a FIQ questionnaire. Blood levels of TNF-(, interleukins (IL-1, IL-2 and IL-10) and PGAM-I expression in patients' saliva were also evaluated. Patients with FM showed significant improvements in their clinical status after treatment. Also, FM patients has IL-10 levels lower than healthy women and the balneotherapy increased the expression of this cytokine in both groups, concomitantly to pain relief. Although inflammatory cytokines (IL-1, IL-2 and TNF-() were more expressed in FM patients than healthy patients their levels did not reduce after treatment. A slight increase of PGAM-I expression was observed. In conclusion, IL-10 levels could be a useful biomarker to balneotherapy follow-up of FM patients. However, these findings must be analyzed in a larger number of patients in order to validate IL-10 as an effective biomarker.

Effectiveness of short-term physical agents treatment on macroscopic morphology in patients with plaque psoriasis / Efectividad del tratamiento a corto plazo de los agentes físicos en la morfología macroscópica de las placas de psoriasis

Psoriasis is a chronic inflammatory disease that presents skin rashes which can arise through plaques. The aim of this work was to compare the effectiveness of short-term physical agents treatment on macroscopic morphology (area and erythema) in patients with plaque psoriasis. This prospective randomized experimental study included fourteen subjects, medically diagnosed with psoriasis, with more than one plaque in the skin and voluntarily without topical treatment. All subjects completed the study that consisted of 12 treatment sessions divided in control (C), artificial balneotherapy (AB), phototherapy (PT) or balneophototherapy (BPT) groups. After session 12, there was a significant reduction of the plaque area by all treatments when compared to C group and BPT was the most effective one. However, only AB and PT presented a reduction of erythema. Regarding severity, 9 patients changed to a lower category on the PASI test, and 5 of them maintained a mild psoriasis, but lowered their score. Finally, 13 of 14 subjects improved their quality of life. The physical agents used reduced the severity of psoriasis and improved quality of life of patients after 12 sessions of treatment during a onemonth period. The BPT was the more effective in controlling psoriasis by diminishing its area and PT by attenuating the erythema.

La Psoriasis es una enfermedad inflamatoria crónica que presenta irritación cutánea que puede derivar a placas. El objetivo de este trabajo fue comparar la efectividad del tratamiento a corto plazo con agentes físicos en la morfología macroscópica (área y eritema) en pacientes con placas de psoriasis. Estudio experimental, prospectivo, randomizado. Catorce sujetos participaron con diagnóstico médico de psoriasis, con más de una placa en la piel y sin tener tratamiento tópico de forma voluntaria. Todos los sujetos completaron el estudio, el cual consistió de 12 sesiones de tratamiento dividido en grupo control (C), BA, FT y BFA. Posterior a la sesión 12, se observó una reducción significativa en toda el área de las placas que recibieron tratamiento al compararlas al grupo C y el grupo BFA fue el más efectivo. Sin embargo, solo los grupos BA y FT presentaron una reducción del eritema. Respecto a la severidad, 9 pacientes cambiaron de la baja categoría en el test de PASI y 5 de ellos se mantuvieron en el nivel medio, pero disminuyeron su puntaje. Finalmente, 13 de 14 sujetos mejoraron su calidad de vida. Los agentes físicos usados redujeron la severidad de la psoriasis y mejoraron la calidad de vida de los pacientes después de 12 sesiones de tratamiento durante el período de un mes. La BFA fue la más efectiva en controlar la psoriasis por la disminución en el área y la FT por la atenuación del eritema.

Hydrotherapy and crenotherapy in the treatment of pain: integrative review / Hidroterapia e crenoterapia no tratamento da dor: revisão integrativa

ABSTRACT BACKGROUND AND OBJECTIVES: The Integrative and Complementary Practices were implemented in the Unified Health System as adjunctive modalities in the treatment of pain. This article focuses on crenotherapy and hydrotherapy, whose agents are the natural mineral waters and common for the rehabilitation of functional alterations. The scarcity of these practices for the treatment of pain in the literature justifies this review. This study aimed to check the scientific productions about the efficacy of balneology/balneotherapy/crenotherapy and hydrotherapy in the treatment of pain. CONTENTS: It is an integrative review, carried out in May 2018, searching in the electronically available scientific articles, in full, in the LILACS, Pubmed, BVS and CINAHL database in periodicals published in the last 10 years focusing on crenotherapy and hydrotherapy for pain relief, in the Portuguese, English and Spanish language. The descriptors used were: "Pain", "Balneology", "Crenotherapy", "Hydrotherapy" "Efficacy"; "Effectiveness" in the three languages, combined with the Boolean expressions AND/Y/E and OR/O/U/OU, finding 2306 articles, of which 111 were identified, and only 27 met the inclusion criteria, analyzed and incorporated the evidence that emerged in pain relief. CONCLUSION: This study showed that most of the evidence emerged from the studies analyzed regarding the efficacy of hydrotherapy and balneology in pain pictures focused on levels 1 to 3. Of the 27 studies, 18 showed the efficacy of hydrotherapy and eight of balneology in the pain symptomatology and one in relation to the lack of knowledge of the use of these complementary therapies in pain relief.

RESUMO JUSTIFICATIVA E OBJETIVOS: As Práticas Integrativas e Complementares foram institucionalizadas no Sistema Único de Saúde como modalidades coadjuvantes no tratamento da dor. Este artigo focalizou a utilização de crenoterapia e hidroterapia, cujos agentes são as águas minerais naturais, comum para a reabilitação de alterações funcionais. A escassez da literatura dessas práticas no tratamento da dor, justifica esta revisão. O objetivo deste estudo foi verificar a produção cientifica sobre a eficácia da balneologia/balneoterapia/crenoterapia e da hidroterapia no tratamento da dor. CONTEÚDO: Revisão integrativa, realizada em maio de 2018, cuja busca de artigos científicos disponíveis eletronicamente e na íntegra, na base de dados, LILACS, Pubmed, BVS e CINAHL em periódicos publicados nos últimos 10 anos enfocaram a crenoterapia e hidroterapia para o alívio da dor nos idiomas Português, Inglês e Espanhol. Os descritores utilizados foram: Dor, Balneologia, Crenoterapia, Hidroterapia, Eficácia; nos três idiomas, combinados com as expressões booleanas AND/Y/E e OR/O/U/OU encontrando 2306 artigos, identificados 111 e destes, apenas 27 atenderam aos critérios de inclusão, analisados e incorporadas as evidências emergidas no alívio da dor. CONCLUSÃO: Este estudo mostrou que a maioria das evidências emergidas dos trabalhos analisados quanto à eficácia da hidroterapia e crenoterapia em processos álgicos concentraram-se nos níveis 1 a 3. Dos 27 estudos, 18 mostraram a eficácia da hidroterapia e oito da balneoterapia e crenoterapia nos sintomas dolorosos, e um em relação ao desconhecimento do uso dessas práticas integrativas no alívio da dor.

A Survey on the Awareness of Balneotherapy in Dermatologic Outpatients and Dermatologists / 대한피부과학회지

BACKGROUND: Balneotherapy, although not a well-established treatment, has been used for dermatologic diseases from ancient to modern times. However, there is little knowledge regarding the current awareness of balneotherapy in dermatologic patients and dermatologists. OBJECTIVE: To understand the current situation of balneotherapy, we first evaluated the utilization and awareness of balneotherapy among dermatology outpatients and dermatologists. METHODS: A written questionnaires were completed by 183 outpatients who visited the Department of Dermatology at a University Hospital. Online questionnaires were completed by 37 dermatologists. RESULTS: Only a small percentage of the outpatients used thermal springs/spas for therapeutic purposes. On the contrary, 93% of them used it for leisure and rest. Most outpatients thought the cleanliness of water is the most important factor in thermal springs/spas. Both outpatients (81%) and dermatologists (81%) regarded balneotherapy as a medically unestablished folk remedy. Though regarded as a folk remedy, almost all outpatients (98%) thought that balneotherapy helps improve general health problems, such as fatigue and skin diseases, or conditions related to blood circulation, pain, and joint/muscle. Participants thought that dermatology and rehabilitation medicine can be connected to balneotherapy. Although they thought that balneotherapy can improve general health, most dermatologists (70%) mentioned that it is difficult to judge the efficacy of balneotherapy owing to the lack of sufficient evidence. CONCLUSION: Although not yet considered as a confirmative therapeutic modality owing to the lack of medical verification, there is positive recognition and outlook for the effect of balneotherapy in Korea. To offer precise information to patients, more attention from dermatologists would be needed to confirm its actual efficacy.

Balneotherapy is a potential risk factor for Pseudomonas aeruginosa colonization

ABSTRACT The practice of immersion in burn patient has been abandoned in many parts of the world but in Brazil it is still common. The aim of this study was to ascertain if balneotherapy is a risk factor for Pseudomonas aeruginosa colonization in thermally injured patients. Eighteen patients from a Burn Center were studied for 14 weeks for Pseudomonas aeruginosa. Samples were collected by swabbing the exudate of wounds, before and after giving bath to the patients and from balneotherapy table. Pulsed-field gel electrophoresis was used to determine bacterial genetic relatedness. Thirty-seven P. aeruginosa isolates were detected from 292 swabs collected from patients' burn surface area and from the balneotherapy table. Profile analysis of P. aeruginosa DNA fragmentation showed 10 clones among the 37 strains analyzed. Type A is the most prevalent clone, with 23 strains distributed into eight subtypes. These were present in the swabs collected, before and after the patients' bath, from the surface of the bath table, suggesting that there was cross-contamination between the patients in different ways. This work demonstrates that balneotherapy is a risk factor in the Burn Center studied, because the same clone was found among P. aeruginosa isolates collected at various points and times.

RESUMO A prática de balneotarapia em paciente queimado foi abandonada em muitas partes do mundo, mas no Brasil ainda é comum. O objetivo deste estudo foi verificar se a balneoterapia é um fator de risco para a colonização por Pseudomonas aeruginosa em pacientes queimados. Dezoito pacientes internados em um Centro de Queimadura (CQ) foram acompanhados por 14 semanas. Amostras foram coletadas do exsudato de feridas, antes e depois do banho dos pacientes e também da mesa onde a balneoterapia foi realizada. A relação genética entre as cepas de P. aeruginosa foi determinada pela electroforese em gel de campo pulsado. Trinta e sete cepas foram detectadas a partir de 292 swabs coletados de área de superfície das feridas dos pacientes e da mesa de balneoterapia. Análise de fragmentação do DNA das 37 P. aeruginosa mostrou a existência de 10 clones. O tipo A foi o clone mais prevalente, com 23 cepas distribuídas em oito subtipos. Estas estavam presentes nas lesões dos pacientes antes e após o banho e na mesa onde o banho foi realizado, sugerindo contaminação cruzada inter e intra-pacientes e pacientes e mesa de banho. Este trabalho mostra que a balneoterapia é um fator de risco para colonização por P. aeruginosa, no CQ estudado, pois um mesmo clone da bactéria foi encontrado nos isolados coletados em vários pontos e épocas diferentes.

Immunomodulatory Effects of Deokgu Thermomineral Water Balneotherapy on Oxazolone-Induced Atopic Dermatitis Murine Model

BACKGROUND: Although the therapeutic mechanism of balneotherapy for atopic dermatitis has not been clarified, many atopic patients who visit thermomineral springs have shown clinical improvements. OBJECTIVE: This study was aimed to evaluate the immunomodulatory effect of thermomineral water balneotherapy on the atopic dermatitis murine model. METHODS: The oxazolone-induced atopic dermatitis murine model was used to evaluate the therapeutic effect of balneotherapy with Deokgu thermomineral water compared with distilled water. Histologic evaluation and confocal microscopic imaging were performed to analyze the lesional expression of cluster-of-differentiation (CD)4 and forkhead box p3 (Foxp3). Lesional mRNA expression of interleukin (IL) 33, thymic stromal lymphopoietin (TSLP), and Foxp3 was evaluated by real-time reverse transcription polymerase chain reaction. RESULTS: Compared with the distilled water bath group, confocal microscopic evaluation of CD4 and Foxp3 merged images showed increased expression of regulatory T cells in the thermomineral balneotherapy group. The lesional mRNA level of IL-33 showed a reduced trend in the thermomineral balneotherapy group, whereas the level of mRNA of Foxp3 was increased. TSLP showed a decreased trend in both distilled water and thermomineral water bath groups. There was a trend of reduced expression in lesional IL-33 mRNA but increased cell count of CD4+ Foxp3+ regulatory T cells in thermomineral balneotherapy compared with distilled water bath. CONCLUSION: Therefore, thermomineral balneotherapy can be an effective and safe adjuvant therapeutic option for atopic dermatitis.

Eighty Years of the Japanese Society of Balneology, Climatology and Physical Medicine / 日本温泉気候物理医学会雑誌

  The Japanese Society of Balneology, Climatology and Physical Medicine (JSBCPM) was founded in 1935 with the aim of researching the scientific bases of balneotherapy. The Society was admitted as the 15th affiliated member of the Japanese Association of Medical Sciences, which consists of 123 medical societies today. The scientific meeting of the Society has been held annually and the 80th anniversary meeting was celebrated in 2015.<BR>  The number of members has gradually increased over the past 30 years due to rising interest in balneotherapy. The members counted 1914, including 976 balneotherapists who had completed a training course for balneotherapy of which 221 were Society-certified balneotherapy specialists in 2015. The Society has held a training course for balneotherapy and study meetings in 7 areas of Japan once a year to promote balneology. The official journal (J. Jpn. Soc. Balneol. Climatol. Phys. Med.) has been issued quarterly and several textbooks relating to spa treatment have been published by the committee of the Society. <BR>  In the annual scientific meeting, several special lectures and an average of 50 free papers have been presented. The main concerns of the members, assumed from the percentage of titles of papers appearing in J. Jpn. Soc. Balneol. Climatol. Phys. Med., had been spa bathing treatment followed by climatology and the chemistry of hot springs water up until volume 50; however, they have recently shifted to the physiology of heat stimuli, health promotion with spa bathing and mox and acupuncture instead of climatology and chemistry.<BR>  The Society reported “the indications and contra-indications of spa treatment” in 2010 after 5 years’ research into medical references on balneology by request of the Ministry of the Environment. Based on this report the official notification for indications and contra-indications of balneotherapy was changed in 2014 by the Chief of Natural Environment in the Ministry of the Environment. The organization of balneotherapists has performed several studies on the effect of balneotherapy and reported the results of them in J. Jpn. Soc. Balneol. Climatol. Phys. Med., volumes 65 and 74.<BR>  The 39th Congress of the International Society of Medical Hydrology and Climatology (ISMH) was successfully held in Kyoto under the sponsorship of JSBCPM in 2014.

Eighty Years of the Japanese Society of Balneology, Climatology and Physical Medicine / 日本温泉気候物理医学会雑誌

  The Japanese Society of Balneology, Climatology and Physical Medicine (JSBCPM) was founded in 1935 with the aim of researching the scientific bases of balneotherapy. The Society was admitted as the 15th affiliated member of the Japanese Association of Medical Sciences, which consists of 123 medical societies today. The scientific meeting of the Society has been held annually and the 80th anniversary meeting was celebrated in 2015.   The number of members has gradually increased over the past 30 years due to rising interest in balneotherapy. The members counted 1914, including 976 balneotherapists who had completed a training course for balneotherapy of which 221 were Society-certified balneotherapy specialists in 2015. The Society has held a training course for balneotherapy and study meetings in 7 areas of Japan once a year to promote balneology. The official journal (J. Jpn. Soc. Balneol. Climatol. Phys. Med.) has been issued quarterly and several textbooks relating to spa treatment have been published by the committee of the Society.   In the annual scientific meeting, several special lectures and an average of 50 free papers have been presented. The main concerns of the members, assumed from the percentage of titles of papers appearing in J. Jpn. Soc. Balneol. Climatol. Phys. Med., had been spa bathing treatment followed by climatology and the chemistry of hot springs water up until volume 50; however, they have recently shifted to the physiology of heat stimuli, health promotion with spa bathing and mox and acupuncture instead of climatology and chemistry.   The Society reported “the indications and contra-indications of spa treatment” in 2010 after 5 years’ research into medical references on balneology by request of the Ministry of the Environment. Based on this report the official notification for indications and contra-indications of balneotherapy was changed in 2014 by the Chief of Natural Environment in the Ministry of the Environment. The organization of balneotherapists has performed several studies on the effect of balneotherapy and reported the results of them in J. Jpn. Soc. Balneol. Climatol. Phys. Med., volumes 65 and 74.   The 39th Congress of the International Society of Medical Hydrology and Climatology (ISMH) was successfully held in Kyoto under the sponsorship of JSBCPM in 2014.

Efficacy of Balneotherapy as an Adjuvant Treatment for Atopic Dermatitis at Yuseong Spa, Korea / 대한피부과학회지

BACKGROUND: Long-term use of various topical and systemic therapies for atopic dermatitis is associated with cutaneous and systemic adverse effects. Balneotherapy as an adjuvant treatment for atopic dermatitis has been extensively studied, and is considered effective and safe, in many countries. However, there is limited evidence from Korea, with only one previous report on the subject. OBJECTIVE: The aim of this study was to investigate the therapeutic efficacy and safety of balneotherapy in the treatment of atopic dermatitis in a Korean population. METHODS: Thirty atopic dermatitis patients were included in this randomized clinical trial evaluating the therapeutic efficacy of balneotherapy at Yuseong Spa, for four weeks. The patients were assigned to two groups: the control group (allowed treatment only) and balneotherapy group (additionally treated with balneotherapy). Assessment was made at baseline, and after 1, 2, and 4 weeks of treatment. RESULTS: At week 4, compared with the control group, the balneotherapy group showed significantly greater improvement in the eczema area and severity index score, physician's global assessment, patient's self global assessment, and in the measured value of transepidermal water loss. The visual analog scale for pruritus in the balneotherapy group decreased, whereas it increased in the control group. None of the patients experienced any adverse events. CONCLUSION: Our study suggests that balneotherapy may be beneficial, is safe, and may increase the quality of life for patients with atopic dermatitis.

07-5The effectiveness of Balneo-Logotherapy (BLT) toward fibromyalgia (FMS) / 日本温泉気候物理医学会雑誌

<b>Background: </b>The pathogeneses of fibromyalgia syndrome (FMS) are related with the living way of a patient, that holds biopsychosocial-existential problems. Especially existential problems are more essential; such patients are sometimes in existential vacuum. It is impossible to care the patients by onlharmacotherapy; that needs psychotherapy and physical therapy. Logotherapy and existential analysis (LTEA) was established by Prof. Viktor Frankl to save such patients, that is one of the experimental psychotherapy. Balneotherapy (BT) is popular all around the world to cure stressful patients.<BR><b>Objective: </b>We have developed Balneo-logotherapy (BLT) for patients with FMS by adding LTEA to the BT, which mainly consists of treatment carried out by taking bathes at a hot spring, a non-ordinary place. We also determined the prognosis one year after the therapy.<BR><b>Method of BLT: </b>After enough motivation and the informed consent, a patient begins BLT program. The mean duration of the therapy was 4.5±1.2 weeks. During the period from the start of the BLT until the time the patient was relieved of Yuatari phenomenon (thermal crisis, bath reaction, YP), the patient was directed to do nothing. Therapist should pay attention to help the patient to overcome YP. After this period, the patient was given free time to do things such as taking a walk. Throughout the period of BLT, patients should write in the simple diary every day and record what they became aware concerning the body and the mind. <BR><b>Subjects and methods: </b>Subjects were 65 patients with FMS (42.0 yrs±11.5, Male: Female = 24:41). Based on pathogenesis, FMS patients were classified into two groups: psychosomatic (PSD) Type (n=30) and PTSD Type (n=35). PSD type was mainly caused by loss of bodily sense (alexithymia) and hyper-adaptation. PTSD Type was mainly caused by trauma such as ill-treatment and war experience. The relationship between having YP or not and the prognosis was also determined.<BR><b>Results: </b>Overall recurrence rate was 30.8%. Recurrence rates for each type were: 23.3% for PSD Type FMS, and 37.1% for PTSD Type. Incidence of YP occurrence was: 80.0% for all cases, 86.7% for PSD Type and 74.3% for PTSD Type. The more severe YP, the better the prognosis (p<0.05). One year after the therapy, cases without recurrence accounted for 69.2% of all the cases. In PSD Type, recurrence was not seen in 73.3%. In PTSD Type, recurrence was not seen in 65.7%. Recurrence rate was lower for the group of patients with development of YP. <BR><b>Discussion: </b>Therapeutic self is most important; to create interpersonal communication to tune in the patient to get aware of intrapersonal communication (according to biopsychosocial-existential model) of the patient. Patient’s psychological movements were; Dependency ⇒ Awareness ⇒ Autonomy ⇒ Reset of the mind (through YP and ASC) ⇒ Intervention by the therapist to make change in behavior through the awareness of his own meaning of life. In this process, occurrence of YP is meaningful. A hot spa is a very suitable place to perform psychotherapy like logotherapy.

07-2Evaluation of crenobalneotherapy for knee osteoarthritis, an update of a systematic review / 日本温泉気候物理医学会雑誌

<b>Background</b>: Although crenobalneotherapy is used commonly for the treatment of knee osteoarthritis, scientific evidence from our previous systematic review on its efficacy was not strong enough.<BR><b>Objective:</b> To conduct an update of a previous systematic review by analyzing each component of crenobalneotherapy separately for knee osteoarthritis.<BR><b>Data sources</b>: A computerized MEDLINE literature search (1966 to October 2013) was performed and personal data and references were added. Studies that compared crenobalneotherapy to any other intervention or to no intervention were selected.<BR>Study eligibility criteria<BR>  Comparative studies published in English or French, evaluating one of the components of crenobalneotherapy (use of mineral water, massages, showers, baths, mud packs and/or water exercises) on patient with knee osteoarthritis were selected. <BR><b>Data collection and analysis</b>: A checklist was used to assess the internal validity, external validity and the quality of statistical analyses. We analyzed several components of crenobalneotherapy separately. We also analyzed the effect of crenobalneotherapy on 4 types of judgment criteria, pain, function, stiffness and quality of life.<BR><b>Findings & conclusion: </b>Crenobalneotherapy appears to improve pain, function, stiffness and quality of life in knee or hip osteoarthritis patients. The efficacy of multiple mineral interventions, as a whole, including water exercise, has a high level of evidence, but, when analyzed for each component the efficacy is not very well validated except for water exercise and heat application. Additional studies with higher methodological quality and larger sample sizes are needed.

09-3New approach to water treatments: hydrology, balneotherapy and thalassotherapy the new health tourism / 日本温泉気候物理医学会雑誌

  New ways to attend patients and pathologies are developing due to scientific results and evolution of installations, techniques, aparatology at water treatment centers.<BR>  We present a way to understand changes in mentality and patients needs. Our model proposes a combination of water centers, spa, balneary and thalassotherapy.<BR>  The first center is a Spa with medical wellness clinic in the city of Marbella. A favorite holiday destination in Spain. Objective of clients is having a holidays plus some spa programs, mostly, relaxing with psychological concerns. Slimming programs to lose weight are indicated along with individualized diet and a complete special physical exercise program based on aquagym and some attractive sports. Beauty programs are demanded by the female public that can be completed with small non invasive aesthetical procedures. Bioenergy medicine and natural treatments based in bioelectricity, electromagnetic fields and oriental techniques.<BR>  Programs recommended at Carratraca Balneary:<BR>  The balneotherapy center is located in the mountains of Malaga. Climatological conditions are special and the thermal waters rich in sulfur, bicarbonate, calcium, magnesium and radon.<BR>  Traditional programs as rheumatological treatments, rehabilitation, respiratory, dermatological and digestive by hydropinic cure, but there is a new concept: The medical offer can be extended and divided in several units:<BR>- Fertility and women unity. Due to the excellent results as antinflamatory and endocrine stimulation.<BR>- Cardiovascular unit: most of the patients present some risk factors as high blood pressure, diabetes, obesity, tabaquism, cholesterol…that have indication for a deeper approach.<BR>- Healthy Aging and preventive medicine by the antioxidant properties of water and also because the genetic unit can provide early detection of potential genetic variants and information about the oncotest, cardiogenetic test, and nutritional genetic test.<BR>- The traditional slimming programs can also be implemented by new devices for physical activity; this allows the specialists to control the type of exercise and results, not only at the stay but by distance through several on line and video applications. This way responsible specialists have a complete control of the patient over the time, fidelization, coming back to our centers for periodical controls.<BR>- Detoxification programs.<BR>  The third option is the thalasso therapy center, due to the benefits of sea water and climatology of the coast are ideal for several programs:<BR>- Dermatological problems<BR>- Osteoarticular pathologies, with physiotherapy and osteopathy specialists.<BR>- Psychological and psychosomatic problems.<BR>- Retreat treatments where not only physical and psychological helps are provided by spiritual approach by the specialist and group techniques and individual coaching.<BR>- Oncological diseases, as useful to help syntomathology and quality of life.<BR>  Finally all the compounds of sea water are part of thalassotherapy such as micro and macroorganisms. Assisted therapy with sea lions and dolphins (otaridotherapy and dolphintherapy) could be part of the programs. A complete team of professionals with psychologist, physiotherapist, special educators, doctors, nurses and animal trainers are necessary.<BR>  Pathologies such as hyperactivity, autism, Down’s Syndrome for children can be treated. Families can participate not forgetting pathologies such as rheumatic fibromyalgia, Parkinson’s disease, multiple sclerosis and so on with scientific results published in the last years.

11-1Mud therapy in rheumatic diseases / 日本温泉気候物理医学会雑誌

<b>Objectives:</b> Mud Therapy or peloidotherapy is implemented to treat various diseases; rheumatic gynecological, dermatologic, gastrointestinal disorders etc. It is mostly used for treating rheumatic diseases in Turkey. We summarize the results of our studies that aimed to investigate the effects of mud therapy in rheumatic conditions.<BR><b>Materials and Methods: </b>In last five years (2008-2013) we conducted 6 study to investigate the beneficial effect of mud therapy in rheumatic diseases. These rheumatic conditions are knee osteoarthritis (two studies) ankylosing spondylitis, rheumatoid arthritis, hand osteoarthritis and fibromyalgia. The same mud was applied in all diseases and it is a kind of clay contains mineral water. Patients who participated to studies were recruited from among patients seeking medical advice in Outpatient Clinic of Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty. They are randomized to two groups with a computer method in each study. Research procedures were set according to property of each disease. Temperature of mud and water, treatments of control groups, number of application and application area showed differences. Outcome measures were carried out a blinded physician in certain measurement times (week 0, week 2, week 12, week 24). Results of studies were calculated and analyzed with SPSS statistical program.<BR><b>Results: </b>Ankylosing Spondilitis: Patients in Group 1(Hydrotherapy + mud therapy + home exercises) showed superior improvement on pain and Group 2(supervised exercises +home exercise) had superior development of flexibility and mobility comparing each other. <BR><b>Knee osteoarthritis 1:</b> Patients in group 1 (traditional group, had hydrotherapy + mud therapy five times per week for 2 weeks) and patients in group 2 (had hydrotherapy + mud therapy two or three times weekly for four consecutive weeks) showed similar improvements on patients with knee osteoarthritis.<BR><b>Knee osteoarthritis 2:</b> Patients in Group 1 (mineral water bath +mud therapy) and group 2 (tap water bath +mud therapy) showed statistically significant improvement on pain and WOMAC parameters besides Group 1 showed significant improvement on HAQ and SF-36 parameters at the end of therapy period and at week 12 comparing to baseline. <BR><b>Fibromyalgia: </b>Group 1 (hydrotherapy + mud therapy; consecutively) and group 2 (hydrotherapy + mud therapy; intermittently) had treatment totally same amount. The consecutive or intermittent delivery of ambulatory balneotherapy programs, both are affective in the treatment of fibromyalgia. <BR><b>Hand Osteoarthritis:</b> Group 1 (had balneotherapy with thermo mineral water) and Group 2 (had mud therapy) assessed as measuring pain, grip strength by hand dynamometer and hand functional indexes. They showed similar improvement after therapy period and it lasts 6 months in both groups. <BR><b>Rheumathoid arthritis: </b>Group 1 (mud pack therapy + conventional medication) showed superiror improvement on pain and HAQ compared to Group 2 (conventional medication). Mud therapy is an adjuvant therapy for rheumatoid artrhritis and it is an effective treatment modality to relieve pain and improve quality of life in short and middle term up to 12 weeks.<BR><b>Conclusions:</b> These results indicate that mud therapy has beneficial effects on these varius originated rheumatic diseases.

PT2-1EBM Balneotherapy in Hungary / 日本温泉気候物理医学会雑誌

  Hungary is rich in thermal mineral waters. Here, we present a systematic review and meta-analysis of clinical trials conducted with Hungarian thermal mineral waters, the findings of which have been published by Hungarian authors in English. The 124 studies identified in different databases include 20 clinical trials. Seven of these evaluated the effect of hydro- and balneotherapy on chronic low back pain, four on osteoarthritis of the knee, and two on osteoarthritis of the hand and one ostheoarthrtis of shoulder. One of the remaining seven trials evaluated balneotherapy in chronic inflammatory pelvic diseases, while six studies explored its effect on various laboratory parameters. Out of the 20 studies, 9 met the predefined criteria for meta-analysis.The results confirmed the beneficial effect of balneotherapy on pain with weightbearing and at rest in patients with degenerative joint and spinal diseases. A similar effect has been found in chronic pelvic inflammatory disease. The review also revealed that balneotherapy has some beneficial effects on antioxidant status, and on metabolic and inflammatory parameters.Based on the results, we conclude that balneotherapy with Hungarian thermal-mineral waters is an effective remedy for lower back pain, as well as for knee and hand and shoulder osteoarthritis.

PT1-1Effect of balneotherapy on microcirculation in diabetic patients / 日本温泉気候物理医学会雑誌

<b>Introduction:</b> In diabetic patients we can observe disturbance of microcirculation since the initial stage of diseases. That is the reason of many heavy complication of diabetes. Balneological procedures have most important value in complication of microcirculation treatment but there is not much science evidences. The aim of our research was to define influence of selected balneological procedures on skin microcirculation in patients with long time diabetes.<BR><b>Materials:</b> 35 diabetes type 2 patients without clinical symptoms of peripheral circulation disorders in lower extremities. Most of them (30 patients) were treated by insulin injections, rest of them only by oral antidiabetes drugs. All of our patients had good control diabetes during observation. <BR><b>Methods: </b>Treatment program consist of 3 balneological procedures applied everyday by 21 days of thermal treatment. Applied following procedures: CO₂ bath, salt bath with exercises, peat - paste poultices. Every patients gets 16-18 procedures during the time of thermal treatment program. Microcirculation examination had been done before and after treatment by using laser - doppler method in occlusion test.<BR>  7 parameters of microcirculation had been estimated; most valuable of them were: MAX (maximal flow after occlusion), MAX/RF (relations of maximal flow after occlusion to rest flow), TL (time of vessels reaction after occlusion), TM (time to reach of maximal flow after occlusion). <BR><b>Results: </b>We receive high statistical important changes: increasing of MAX (average value; before: 0.828571 pu - perfusion unit., after: 0.950571 pu.), increasing of MAX/RF (average value; before: 1.4246, after: 1.6611), decreasing of TL (average value; before: 0.5031 s., after: 0.4058 s.), decreasing of TM (average value; before: 0.8428 s., after: 0.7811 s.)<BR><b>Conclusions:</b> Our researches are evidence on valuable influence of selected balneological procedures on microcirculation in diabetic patients.

PT1-2Current status balneotherapy in Spain / 日本温泉気候物理医学会雑誌

  Balneotherapy or Health Resort Medicine has a long tradition in Spain. This tradition is still alive today. The main indication of balneotherapy in Spain is rheumatic diseases, especially joints’degenerative disorders.<BR>  There are, approximately, 2,000 mineral water springs with the public utility declaration.<BR>  There are also currently working 119 Thermal Stations, which have 19,154 hotel rooms, with 4,047,000 overnight stays in 2012. They employ 5,310 workers and 904,000 customers enjoy, although not all of them are go in sanitary programs. Total revenue of thermal stations is 255 million euros.<BR>  Balneotherapy research in Spain takes place mainly at the Complutense University of Madrid, in the Professional School of Medical Hydrology and Department of “Physical Medicine and Rehabilitation. Medical Hydrology” (Medicine Faculty) and other Universities such as those of Extremadura, Granada, Seville, Vigo and Zaragoza. Hydrotherapy and Aquatic Therapy in Universities: Catolica San Antonio de Murcia, Extremadura, Granada and Malaga and natural mineral waters in the Complutense University of Madrid.<BR>  Moreover, this year we celebrate 25 years of the Balneotherapy Program of the Elder’s Institute and Social Services (IMSERSO) under the Ministry of Health. The program had 12,848 beds in 28 Spas in 1989 to 209,222 in 2014 in 105 Spas, which in economic terms means moving from 4.3 million euros provided by the IMSERSO in 1989 to 34 million in 2014, with an economic impact of more than 115.2 million adding the contribution of the beneficiaries. More than 2,500,000 people have benefited the program since its implementation.

We lost a giant in our field. Overview of the late Professor S. Sukenik’ works on Balneotherapy and Climatotherapy / 日本温泉気候物理医学会雑誌

  We used the data published recently by a team headed by the late Professor Shaul Sukenik, in order to shed light on the huge amount of work realized by this exceptional physician, who devoted his life to his family, his profession and the Dead Sea. <BR>  Particularly, he wanted very early - and always succeeded - to apply the strictest rules of clinical studies in the fields of Balneotherapy and Spa treatment, thus lifting them up to their highest level of credibility. Thanks to his works, one can stipulate with authority that Dead Sea treatments are beneficial in several rheumatologic disease and have a good safety profile.<BR>  The Dead Sea, the deepest and most saline lake on earth, has been known from biblical times for its healing properties. The systematic review presented critically the level of evidence for the claims of therapeutic effects of Dead Sea treatments in several rheumatologic, skin and lung diseases and, as well, reviewed these treatments’ safety.<BR>  The authors found bona fide evidence that Dead Sea treatments are especially effective in psoriasis due to both special characteristics of solar ultraviolet radiation and Dead Sea water balneotherapy. Dead Sea mud and balneotherapy have been found to be beneficial in rheumatologic diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and knee osteoarthritis.<BR>  In the safety analysis, no evidence was found for an increase in skin neoplasia, although skin actinic damage seems to be amplified in patients treated in the Dead Sea. Dead Sea treatments do not lead to worsening of high blood pressure. Substantial ingestion of Dead Sea water (generally in unusual near-drowning cases) is toxic and can result in cardiac rhythm disturbances because of electrolyte concentration abnormalities. Finally, laboratory analysis of Dead Sea mud did not reveal mineral concentrations that could represent a health concern for their intended use.

S2-2Carbon dioxide (CO₂) balneotherapy in Germany / 日本温泉気候物理医学会雑誌

  Balneotherapy for humans has a long tradition in Germany. Carbonated water or CO₂ containing spring water has been known for ancient times, not only in spas for bathing but also for drinking. In 1845 the German spa physician Dr. F. Bodo from Bad Nauheim noted a “congested, velvety reddened skin” after taking a bath in warm CO₂ enriched water. Conducting absorption experiments Hediger in 1928 demonstrated for the first time that CO₂ is absorbed into the body by passing through the intact skin. In Germany 80% of the natural mineral spas contain the minimum concentration of 400mg/kg CO₂ required for treatment and 50% of all spas have a CO₂ content higher than 1000 mg/kg which is required for the designation as carbon dioxide enriched water. The spa resorts Bad Nauheim and Bad Krozingen harbor natural mineral springs with the world wide highest CO₂ concentrations containing 2600 mg/kg and 2200 mg/kg, respectively. These springs belong to artesian wells which means the spring water is under a hydrostatic pressure that is high enough to well up to the surface without any pumps. <BR>  The beneficial effects of CO₂ balneotherapy are not known in detail yet. However, animal studies have shown that bathing in carbon dioxide rich water enhances collateral blood flow in ischemic hindlimb through mobilization of endothelial progenitor cells and activation of NO system. Daily CO₂ bathing for 28 days induced a 4 fold increase in collateral vessel density which was prevented by the administration of L-NAME a NO inhibitor. In humans CO₂ bathing improves arteriolar blood flow in patients with arterial occlusive diseases. Patients with necrosis of skin and soft tissue due to disturbed blood flow showed profound improvement of the skin defects with decrease of the necrosis area. To the skin CO₂ enriched water has topical effects. Ten days of rinsing detergent-damaged skin with CO₂ enriched water enhanced clinical skin regeneration, enhanced epidermal lipid synthesis and enhanced barrier repair. Taking together CO₂ balneotherapy has different beneficial effects on human diseases. This review presents the effects of CO₂ enriched water on humans diseases and discusses its clinical indications.