Spa Center Research Articles

The effects of balneotherapy on human immune gunction: should baths and mud applications have a role during covid-19 pandemic?

Recent evidences show that balneotherapy applications can affect the immune system, which has an important role in the containment of Covid-19 infection outcomes. It is interesting to consider if balneotherapy, through medical water baths and mud applications can be a suitable treatment in order to influence human immunity in people who have not acquired the infection and in subjects discharged from hospital after Covid-19 recovery. In particular, balneotherapy seems to improve the immune response efficacy, with an effect mediated by mental stress reduction and a direct action, consisting in the modulation of the abnormal inflammation and the enhancement of the immune system, through changes in both cell-mediated and humoral immunity. The main changes demonstrated on human immunity, after balneotherapy, are linked to an increase in the levels and the activity of cells involved in the immune response such as neutrophils and monocytes and to a reduction of the pro-inflammatory cytokines produced by a dysregulated inflammation. Even if further in vitro researches and clinical trials on this topic should be conducted, at present Spa centres, if hygienically controlled according to WHO and national recommendations, may be considered safe places to attend and useful settings to counteract the outcomes of residual unbalanced immunity after Covid-19 infection.

Sulfurous thermal waters stimulate the osteogenic differentiation of human mesenchymal stromal cells – An in vitro study

Strategies aimed at delaying the onset of bone tissue degeneration and the resulting skeletal fragility are key to decrease the risk of bone fracture correlated to ageing. The therapeutic properties of sulfurous thermal waters (STWs), rich in hydrogen sulfide (H2S), have been claimed for centuries. However, the direct regulation of bone cells by STWs has not been investigated yet. Here we aimed at analyzing the effect of STWs on cultured human mesenchymal stromal cells (hMSCs) derived from bone tissue. Two concentrations of STWs from 2 health spa centers in Italy (here named STW-1 and STW-2) containing, respectively, high and moderate quantities of H2S, were added to the culture media. Cytotoxicity and osteogenic differentiation were evaluated. We provided first evidence that treatment of hMSCs with STWs results in a sharp increase in intracellular H2S content, coherent with the different concentrations of H2S, thereby reveling that STWs-released H2S is internalized by cells. STWs treatment significantly induced osteogenic differentiation of hMSCs. In particular, mineral apposition was increased with a similar pattern by the two STWs, while mRNA expression of osteogenic markers (BSP, OC, RUNX-2, OPN) was differently affected. Only STW-2 induced a significant, dose-dependent increase in these gene expression. These findings support the rationale for the use of STWs as a complementary treatment of bone wasting diseases.

Origin, diversity and geothermal potentiality of thermal and mineral waters in Vrnjačka Banja, Serbia

Based on the results of 15 years of research on the physical and chemical parameters of 11 occurrences of thermal and mineral water in the extended area of the spa town of Vrnjacka Banja, diverse hydrochemical types of water have been identified, originating from different lithological formations (serpentinite, schist, marble, etc.). Currently, the total amount of abstracted thermo-mineral water is close to 70 L/s, with water temperatures up to 33.8 °C. However, interpretation of collected data indicates that the chemical composition of the mineral water is not exclusively related to the mineralogical composition of the host rock, i.e., aquifer material. To better understand the genesis of these waters, multivariate statistical analysis was undertaken in combination with hydrochemical interpretation of different ionic ratios. This approach revealed the existence of three distinct clusters of thermal and mineral waters: (1) low temperature, low mineral content and mild alkaline; (2) slightly acidic, with a moderate mineral content and elevated iron and fluoride concentrations; and (3) thermal, rich in CO2, with elevated mineral content and iron, manganese and fluoride concentrations. Two primary hydrogeochemical processes, which influence the composition of the thermo-mineral waters, were also identified: dissolution of serpentinite rocks and dissolution of schists, both enhanced by the presence of CO2 gas, circulating through fault zones. Estimates of available geothermal energy suggest a significant potential for expanding current uses of thermal waters of this most popular spa center in Serbia.

Su Ürünleri Yetiştiriciliğinde Alternatif Bir Tür: Doktor Balığı (Garra rufa)

In this review, the distribution, biology, feeding, breeding potential and commercial importance of doctor fish (Garra rufa), which have increased in importance in recent years due to the intensive use of ichthyotherapy and fish SPA centers, have been emphasized. The doctor fish, which was first used in 1989 for ichthyotherapy purposes, is used in fish SPA centers for fish massage and pedicure purposes, which are of great interest all over the world today. Due to the increased interest and demand for doctor fish for the purpose of ichthyotherapy and fish massage in the health and tourism sector, cultivation of this species is very important in terms of ensuring the demand through aquaculture and preserving natural fish stocks. Although there are various studies on the distribution, biology and genetics of the doctor fish, it has been observed that there are not enough studies and resources about its breeding. The researches about the culture of doctor fish are very few and these studies are on its thermal tolerance range, the effect of feeding frequency on growth, hormone application and larval feeding. The demand for doctor fish is rapidly increasing in our country and in the world, and this increasing demand is met by import or from natural stocks. For this reason, it is essential that the breeding of doctor fish begins immediately in our country.

Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis.

Indoor salt water baths followed by artificial ultraviolet B light for chronic plaque psoriasis.

ROMATİZMAL HASTALIKLARDA KAPLICA TEDAVİSİ

Kaplıca tedavisi birçok hastalığın tedavisinde olduğu gibi kronik romatizmal hastalıkların yönetiminde de önemli bir rol oynamaktadır. Etki mekanizması kimyasal, termal, mekanik ve immünmodülatör olmak üzere geniş bir spektrum içermektedir. Son yıllarda balneoterapinin tek başına veya diğer geleneksel tıbbi tedavilere tamamlayıcı olarak önemi giderek artmaktadır. Çeşitli araştırmalardan elde edilen sonuçlar balneoterapinin faydalı etkilerini ortaya koymaktadır. Bu çalışmada, laboratuar parametreleri ve klinik açıdan yapılan çalışmalar gözden geçirilerek, romatizmal hastalıklarda kaplıca tedavisinin etkisi güncel bilgiler ışığında sunulmuştur.

Groundwater Mining in Contemporary Urban Development for European Spa Towns

Mining activity is usually associated with heavy industry, the degradation of space and areas with a clearly industrial character. In fact, mining can be associated with other functions, such as health resorts, recreation and leisure. In the case of spas specializing in balneotherapy, medicinal underground waters “mineral and thermal” are extracted from local deposits using mining methods, in borehole mines. Mining activity is not the main direction of development of these places, but it remains absolutely essential for maintaining the spa function and offering services in the field of recreation, rest and tourism. The article focuses on the relationship between mining activity and the basic function of spas, the spatial relations between urban development and the spa zone, the range of mineral and thermal water use (natural resources obtained from underground deposits using the borehole method), and above all-the manner of exposing mining facilities in spa space and explaining the importance of these elements. The basis for the discussion featured in the article is constituted the results of an original study carried out by the author, employing field research, in 2018 at the Institute of Cities and Regions Design, Faculty of Architecture of the Cracow University of Technology. Research work was performed in a dozen South-German statutory spas (Baden-Württemberg, Bavaria, Saxony). Four cities representing a much wider group of spa centres were selected for detailed analysis: Bad Buchau, Bad Saulgau, Bad Aibling and Bad Schandau. It was shown that the selected cities were directly related to the mining of groundwater, but at the same time differed significantly in terms of the studied features. The study's conclusions may be useful in programming the development of spa towns operating on the basis of underground medicinal waters, as well as in the creation of concepts and projects on the urban and regional scale. Doi: 10.28991/HEF-2020-01-01-01 Full Text: PDF

Euganean therapeutic mud (NE Italy): Chlorophyll a variations over two years and relationships with mineralogy and geochemistry

The Euganean thermal district (NE Italy) represents a unique reference for therapies based on the topical use of clay materials matured in thermal waters (pelotherapy, mud therapy, mud-pack therapy): approximately one hundred therapeutic spa centers are concentrated within a small area and share the same virgin clays and the same hypersaline hyperthermal groundwater. The therapeutic mud produced in this district is therefore an ideal test bench for assessing the application of scientific procedures aimed to check and improve the quality of spa products. The measurement of chlorophyll a content was previously suggested as a reliable, easy to acquire, economic and reproducible indicator of the “maturation” process; the new data acquired (>650 samples across two years), associated with mineralogical and geochemical data on approximately 30 therapeutic centers, show instead a more complex and different result. By comparing the analytical data of virgin clays (Della Costa lake sediments), therapeutic mud and mud stored excluding photosynthetic activity, chlorophyll a and its derivatives can be considered better indicators of maturation and recycling procedures than the proliferation of photosynthetic microorganisms in maturation ponds.Some mineralogical and geochemical parameters, as well as the content of chlorophyll a and its derivatives, proved to be distinctive of the virgin clays and therapeutic mud; the latter shows gradual variations, in agreement with progressive departure from pristine composition after repeated use and recycling of the therapeutic mud. Minerals and chemical elements concentrated in the fine-grained fractions (such as illite, kaolinite and Rb, among others) are mechanically depleted compared to virgin clays, whereas for pyrite and organic components (including chlorophyll a and its derivatives), spontaneous degradation can be considered.The rather high frequency of sampling (approximately 1 sample/month) over a long time period (two years) also enabled us to learn that the concentration of chlorophyll a and its derivatives is unique to different therapeutic centers: a few of them show dispersed values and are difficult to fit into a linear trend, whereas in several cases the low dispersion points to a reference value of the center and, in this instance, the degradation rate also turns out to be a characterizing feature of the center.Mineralogical and chemical parameters that discriminate virgin clays and therapeutic mud can be therefore used to monitor the maturation procedures. In addition, for chlorophyll a and its derivatives a double effect can be observed: i) spontaneous degradation with the same rate of mud deprived of possible photosynthetic effects, and ii) possible attenuation or balance of decay after appropriate management of the recycling and replenishment of mud.

Rehabilitation in an Italian thermal setting: a new therapeutic strategy for patients with musculoskeletal disability-the results of an Italian survey.

Traditionally, in the past, patients with musculoskeletal diseases visit the spa centers (Salus per aquam) for traditional treatments, including mud therapy, or for holiday. Spas have begun to offer, as the only means of treatment, rehabilitation therapy for patients with musculoskeletal disabilities alone or in association with other traditional thermal therapies. The purpose of this paper is to describe the results of a recent survey on Italian thermal centers conducted by a section of "Rehabilitation in the Thermal Environment" of the Italian Society of Physical Medicine and Rehabilitation. The study investigated the current diffusion, type, and overall quality of rehabilitation treatments performed at the Italian spas. The survey requested information from 174 centers, but only 132 responded by returning the completed questionnaire. Eighty-nine percent of the centers offered rehabilitation therapy for orthopedic-rheumatological diseases, including post-operative conditions (after hip or knee replacement), 37% offered rehabilitation therapy for neurological diseases and 10% rehabilitation for lymph-vascular conditions. Seventy-one percent employed a multidisciplinary team (which included a physiatrist, a physiotherapist, and other figures such as a hydrologist or rheumatologist). The rehabilitative approach generally included therapeutic exercises (land or aquatic therapies), instrumental physical therapies (ultrasounds, electrotherapy, LASER-therapy, and others), and, less frequently, health education and preventive measures. The survey did not investigate respiratory or nasopharyngeal diseases. In conclusion, the results of this survey suggest that rehabilitation, performed in the thermal environment, could be a new opportunity to treat many musculoskeletal disabilities.

Landscape-Recreational Potential of the Sanatorium-Resort Complex "Tamisk"

The article provides an urban planning analysis of the "Tamisk" Spa Resort located in the Alagir Gorge of North Ossetia-Alania and its adjacent territory. The resort has a solid history, and the medical staff has vast experience in treating various diseases with the help of the local climate, landscape and mineral water sources. Since 2002, the resort has been overloaded, since the other spa center "Karmadon", due to the Kolka Glacier sliding in the Karmadon Gorge, has not been functioning until now. The authors of the article consider an example of the reconstruction of the "Tamisk" Resort. The main factors and conditions affecting the formation of the designed environment are identified. The proposed project presents various functional areas and facilities for sports, recreational and recreational purposes, which indicate a high recreational potential of the territory of the complex. The development and expansion of the functions of the resort will create conditions for the growth of the level of medicine, will lead to the improvement of tourism infrastructure, as well as improve the economic and social situation in the nearby settlements and in the region as a whole.

Enhanced Marketing Plan for Wensha Spa Center: A Case in Pasay City, Metro Manila

The marketing plan is an outline of the company’s overall marketing effort that used to focus on resources and plan for its growth and success. The marketing mix is the utmost ultimate concept that consists of various components of marketing tools, which helps to determine a clear and effective strategy to bring a product to market. The main purpose of this study is to assess and analyze the customer’s satisfaction using 6P’s of the marketing mix. The marketing mix is frequently vital when shaping a product or brand’s offer and is mostly related to the four P’s: price, product, promotion, and place. In service marketing, yet, the four Ps are extended to the six P’s or 6 Ps of Marketing to address the diverse nature of services. This study aimed to enhance the marketing strategies of Wensha Spa in Pasay City to improve competitiveness in the market. It determined the profile of the respondents in terms of age, gender, and educational attainment. It ascertained the significant difference in the assessment of the marketing strategy of the respondents when grouped according to profile. The investigation is quantitative using the descriptive method and survey questionnaire as the main tool distributed to the guests after proper validation and reliability testing using Cronbach Alpha. Ethical consideration and proper statistical tools were used, such as frequency, percentage, weighted mean, T-test, and F-Test. The findings help enhanced the 6p’s marketing mix of Wensha Spa, which leads to guest satisfaction and makes it competitive, resulting from attaining more customers and gaining additional revenue. Based on the analysis, the researchers were able to come up with an enhanced marketing plan that will benefit and improve their current marketing strategies to further provide the needed satisfaction of their guests.

Death in a Carbon Dioxide Therapy Bath: A Case Report and Review of the Literature.

Carbon dioxide (CO2) therapy is the subcutaneous or transcutaneous administration of CO2 for therapeutic purposes. Carbon dioxide therapy is used for localized lipolysis, to treat chronic skin conditions, and is a safe treatment. Full-body CO2 baths are offered in European spa centers, in which the clients are placed into full body bags infused with CO2 at an optimal concentration range between 1000 and 1400 mg/L (516 000-722 500 ppm). Commercially manufactured, air-tight bags and accompanying apparatus designed to provide CO2 baths can be purchased for home use. Few human CO2-related deaths have been reported. They have been mostly accidental, consisting of persons trapped in a closed environment in the presence of "dry ice" or solid CO2. There have been no reported deaths of a human undergoing a CO2 therapy at home. We present a case of a middle-aged male found at home completely inside an air-sealed bag wrapped tightly around his body. The bag was connected to a working pump and a CO2 gas tank. The pump was connected through an inflow and outflow circuit to the bag. The inflow tubing for CO2 gas delivery was partially disrupted, while the outflow tubing was intact. The autopsy and toxicology were unremarkable. The cause of death was determined to be asphyxia by vitiated atmosphere as evident by the displacement of oxygen by CO2 and low pressure created inside a "CO2 therapy bath." The manner of death was accidental.

Protection of personnel and patients in diagnosis and therapy with ionizing and non-ionizing radiation

Most of the sources used in physiotherapy use pulse magnetic fields; spark-discharges; radiofrequencies (RF); direct and low-frequency electric currents, electrical pulses; ultraviolet (UV) and infrared (IR) radiation; broad-spectrum lamps; lasers. The most relevant diagnostic sources are MRI scanners emitting static magnetic field, low-frequency fields, RF. The exposure of medical personnel to NIR depends on the type of transmitter, irradiation power, mode of operation, specific application, access of medical personnel to the treatment zone, shielding of the source and workplace, time duration of exposure. Devices for electric current therapy like pulses, ionophoresis therapy, vacuum therapy, emit magnetic field less than several μT. The devices for subthermal therapy emit RF energy up to 9,8 W/kg, compared to 0,4 W/kg basic restriction for whole body exposure. The average daily dose of the staff at 10 patients per day is 18,356 (V/m)2·h. The dose of medical personnel in protective chambers averaged per patient is WE = 23,88 (V/m)2·h. Regard to MRI equipment, the basic restrictions for static magnetic field for normal operating conditions exceed the action values for people at specific risk, also for risk of attracting ferromagnetic materials. In the case of the use of optical sources, power densities exceed the exposure limit values, and therefore the permissible stay is limited to minutes and seconds, and in some cases it is inadmissible. In cosmetic centers, sanatoriums and SPA centres, power densities are significant and some of them are not controlled (tanning beds and IPL systems). The laser systems applied in physiotherapy are mainly class 3R (visible range), which only pose a risk to the eyes, in some cases 1C. For some procedures, lasers of class 3B are also used which cause risk to the eye by intra-beam viewing as well as diffuse reflected radiation. In cosmetic centers where specific lamps and high class (4) lasers are used, there is a risk for serious skin burns and eye damage.

Czy 100 najlepszych hoteli spa w Polsce to rzeczywiście ośrodki spa?

Czy 100 najlepszych hoteli spa w Polsce to rzeczywiście ośrodki spa?

Weakly mineralized nitrogen thermal waters of Russia

Russia has almost all hydrochemical types of underground mineral waters; however, unlike the well-known and popular resorts in the world, they are used very limitedly. In addition to their high medicinal value, mineral waters, when properly marketed, is a natural product that is comparable, and, in many cases, superior in price to that of similar volumes of high-octane gasoline. In addition to the characteristics of the chemical and gas composition, some underground mineral waters in their native state have an elevated temperature and are thermal and hyperthermal. Low-mineralized nitrogen thermae are one of the large groups of mineral waters; they are common in the areas of young tectonic faults in the earth's crust, which frame the mountainous areas. The deposits of thermae within the blocky and folded-blocky structures are fractured water-pressure systems; the thermal waters in the sedimentary and volcanic-sedimentary rocks saturate the reservoir or fissure-interstitial aquifers and are typical artesian basins. The successful development of health resort business in Russia should be, first of all, based on the extensive use of natural therapeutic factors. As clearly confirmed by the experience with spa treatment in both Russia and world practice, accumulated data from researches, thermal mineral waters determine the possibility of creating large spa centers that provide high economic efficiency.

Efficacité de la médecine thermale en psychiatrie

ObjectivesRelatively little known in psychiatry, spa psychiatric medicine is an original approach, which has started to form the subject of thorough assessments. It concerns 3 week spa therapy stays in practice, the patient being totally free and self-sufficient, though having to go to 3 to 4 prescribed daily bathing sessions and to the medical and psychotherapy follow-up provided within the scope of their medical care. Since the beginning of the years 2000, Spa Medicine has been subject to studies that have better shown the outline and its potential application areas. We present you here, through a review of the literature from these past 30 years, the main elements of scientific proof of its therapeutic activity and as a result, its best documented indications in psychiatry. Therefore, the article is stated by chapter, indication by indication. ResultsThe area which brings the best level of proof relates to generalised anxiety disorder. One study called STOP-TAG (Dubois O, Salomon R, Germain C, et al. 2010) (Salamon R, Germain C, Olié JP, Dubois O, 2008) supervised by 2 Inserm units: ISPED in Bordeaux II and Sainte-Anne, brought the proof of a superior efficacy of the therapy compared to Paroxetine over a period of 8 weeks (5 weeks after the end of the course of treatment). This result is supported by other less thorough works that all feed the first initial study. As a consequence, an Austrian study became interested in the effects of spa bathing observed over 3 weeks in burn-out situations. The results show the efficacy of this medical care at the end of the treatment and 3 months afterwards. Subsequently, the interest in a psycho-educative programme carried out in spa therapy for anxiety patients and chronic benzodiazepine consumers, was studied in addiction. The SPECTh study (De Maricourt P, Gorwood P, Hergueta T, Dubois O. et al. 2016) allowed to follow 70 patients, therapeutically stable and motivated in their stopping. Six months after their treatment, 41.42 % of these patients had ceased all consumption and 80 % had reduced by half, whereas 16 % were in a position of therapeutic failure. This area of addiction has not been subject to other studies particularly concerning excessive alcohol consumption or of ta (the indication of which seems by the way less obvious) or tobacco. If few studies have sought to evaluate the significance of Spa Medicine in depressive disorders, many works have brought out the doubtless indirect impact of this practice on reactional depressive states, especially painful chronic states and on a generalised anxiety state. Likewise, it is above all the spa rheumatologists’ works that have brought solid proof of the efficacy of spa therapy and bathing in affective disorders (anxiety, depressive disorder) associated with painful chronic states (fibromyalgia, chronic low back pain, after breast cancer…). As far as the mechanism of action is concerned, numerous hypotheses exist. This is not the place to present them all. However, the result of an original and important pre-study is presented here that highlights the interest of an optimal “letting go” as statistical indicator of a clinical improvement of anxiety in the long run. If the notion of letting go remains to be defined scientifically, it comprises a notion of non-resistance, the giving up of the patient's will to want to control the events, which makes this therapy different from psychological approaches, that are more intellectual directing the patient towards a mastery effort and self and thought control. This specificity in the spa approach by “non-mastered giving up” of its defences and by returning to self, thanks to the taking up again of pleasant physical sensations, often forgotten, seems to be one of the forms of action, psychologically and fundamentally in spa therapy. ConclusionSituated at the interface of general medicine and psychiatry, and between ambulatory medicine and hospital medicine, spa medicine is therefore essentially intended for anxiety disorders, adapting reactional disorders and clinical situations such as severance from Benzodiazepines or psycho-education. Centred on the spa bathing practice, it is also based on the quality of the relation between doctor and patient, on the setting up of a structuring, anxiolytic medicalised environment. Furthermore, these past few years, examples of psycho-educative medical care inspired from cognitive and behavioural therapies have been developed at the heart of the “psy spa resorts”. It is important to appreciate the effort carried out by these spa centres, far away from schools of medicine, that make the effort of bringing thorough scientific proof validating their interest in psychiatry, what is more in areas (anxiety, Benzodiazepine severance, chronic pain, burn-out…) where solutions and therapeutic alternatives are not exactly legion.

Innate/inflammatory bioregulation and clinical effectiveness of whole-body hyperthermia (balneotherapy) in elderly patients with osteoarthritis

Objectives: Balneotherapy with mud application (mud therapy) is a common hydrothermal intervention for the treatment and rehabilitation of elderly patients with osteoarthritis, leading to anti-inflammatory effects. The main purpose of this investigation was to study a role for regulatory T cells in these anti-inflammatory effects. The second objective was to assess whether the neutrophil-mediated innate response is affected by these anti-inflammatory effects.Methods: Thirty-six elderly patients with knee osteoarthritis underwent a 10-day cycle of balneotherapy at a spa center. They received daily sessions of whole-body mud therapy at 40–42 °C, using mineral-medicinal water and mud. IL-8 and TGF-β serum concentrations, percentage of circulating CD4+ CD25+ FOXP3+ and CD8+ CD28– regulatory T cells, and neutrophil phagocytic capacity were evaluated at baseline and at the end of the intervention. Clinical assessments included knee flexion and extension angle, pain, stiffness, physical function and health-related quality of life.Results: All clinical outcomes significantly improved. Circulating concentrations of IL-8 and TGF-β decreased, which correlated with decreased pain and improved knee flexion, respectively. Percentage of CD4+ regulatory T cells decreased, whereas CD8+ regulatory T cells increased. Neutrophil functional capacity increased.Conclusions: Balneotherapy with mud application was effective in the management of osteoarthritis symptoms. The anti-inflammatory effect mediated by cytokines contributed to the improvement in pain and joint function; and changes in the circulating percentage of regulatory T cells seem to be involved in the anti-inflammatory effects. Improvement in neutrophil function after mud therapy reflects an optimal bioregulatory effect on the inflammatory and innate responses.

Spa therapy together with supervised self-mobilisation improves pain, function and quality of life in patients with chronic shoulder pain: a single-blind randomised controlled trial

To determine whether spa therapy has a beneficial effect on pain and disability in patients with chronic shoulder pain, this single-blind randomised controlled clinical trial included patients with chronic shoulder pain due to miscellaneous conditions attending one of four spa centres as outpatients. Patients were randomised into two groups: spa therapy (18 days of standardised treatment combining thermal therapy together with supervised mobilisation in a thermal pool) and controls (spa therapy delayed for 6 months: ‘immediate versus delayed treatment’ paradigm). All patients continued usual treatments during the 6-month follow-up period. The main endpoint was the mean change in the French-Quick DASH (F-QD) score at 6 months. The effect size of spa therapy was calculated, and the proportion of patients reaching minimal clinically important improvement (MCII) was compared. Secondary endpoints were the mean change in SF-36, treatment use and tolerance. One hundred eighty-six patients were included (94 patients as controls, 92 in the spa group) and analysed by intention to treat. At 6 months, the mean change in the F-QD score was statistically significantly greater among spa therapy patients than controls (− 32.6 versus − 8.15%; p < 0.001) with an effect size of 1.32 (95%CI: 0.97–1.68). A significantly greater proportion of spa therapy patients reached MCII (59.3 versus 17.9%). Spa therapy was well tolerated with a significant impact on SF-36 components but not on drug intake. Spa therapy provided a statistically significant benefit on pain, function and quality of life in patients with chronic shoulder pain after 6 months compared with usual care.

Psychoeducational Protocol for benzodiazepines Withdrawal in Spa Center

Benzodiazepines are widely used in France: 11.5 million of consumers (22% with 2 benzodiazepines simultaneously), 131 million of boxes of benzodiazepines were sold in 2012. Annual length of use: anxiolytic 5 months, hypnotic 3.9 months. Risk of fall, Road accident, risk of Abuse and dependence & possible increase risk of Alzheimer disease. Using the fact that spa center are an institutional place not as stigmatizing and less regressing than being in hospital and are able to reduce anxiety disorders (STOP TAG study).

Therapeutic Education in rheumatology: example of both programs "Fibromyalgia" and "Osteoarthritis" set up in the spa center of Dax (France)

The thermal urban area of Grand Dax had the authorization by its administration of supervision (the ARS) to deliver two programs of Therapeutic Education of Patient (ETP) intended for patients reached of chronic pathology : one on the fibromyalgia, the program Fibr' Eau and another on the degenerative osteoarthritis of the members, the program Educ' Arthrose. These two programs were thought and built by the CNETH then gave to the spa center having a multidisciplinary team trained in the ETP. The dispensation of a program ETP is made according to a quite particular dynamics, namely : a shared educational assessment or educational diagnosis shared realized generally by a nurse, the participation of the patients in therapeutic activities then finally an assessment in order to evaluate the competences acquired by the patient. It is on this plan that the programs Fibr' Eau and Educ' arthrose are delivered during the 18 days of water cure in a spa center.