Spa Treatment Research Articles

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis \u2013 2019

Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

Using toponomics to characterize phenotypic diversity in alveolar macrophages from male mice treated with exogenous SP-A1

BackgroundWe used the Toponome Imaging System (TIS) to identify “patterns of marker expression”, referred to here as combinatorial molecular phenotypes (CMPs) in alveolar macrophages (AM) in response to the innate immune molecule, SP-A1.MethodsWe compared 114 AM from male SP-A deficient mice. One group (n = 3) was treated with exogenous human surfactant protein A1 (hSP-A1) and the other with vehicle (n = 3). AM obtained by bronchoalveolar lavage were plated onto slides and analyzed using TIS to study the AM toponome, the spatial network of proteins within intact cells. With TIS, each slide is sequentially immunostained with multiple FITC-conjugated antibodies. Images are analyzed pixel-by-pixel identifying all of the proteins within each pixel, which are then designated as CMPs. CMPs represent organized protein clusters postulated to contribute to specific functions.Results1) We compared identical CMPs in KO and SP-A1 cells and found them to differ significantly (p = 0.0007). Similarities between pairs of markers in the two populations also differed significantly (p < 0.0001). 2) Focusing on the 20 most abundant CMPs for each cell, we developed a method to generate CMP “signatures” that characterized various groups of cells. Phenotypes were defined as cells exhibiting similar signatures of CMPs. i) AM were extremely diverse and each group contained cells with multiple phenotypes. ii) Among the 114 AM analyzed, no two cells were identical. iii) However, CMP signatures could distinguish among cell subpopulations within and between groups. iv) Some cell populations were enriched with SP-A1 treatment, some were more common without SP-A1, and some seemed not to be influenced by the presence of SP-A1. v) We also found that AM were more diverse in mice treated with SP-A1 compared to those treated with vehicle.ConclusionsAM diversity is far more extensive than originally thought. The increased diversity of SP-A1-treated mice points to the possibility that SP-A1 enhances or activates several pathways in the AM to better prepare it for its innate immune functions and other functions shown previously to be affected by SP-A treatment. Future studies may identify key protein(s) responsible for CMP integrity and consequently for a given function, and target it for therapeutic purposes.

Metaphylaxis of urolithiasis in shipboard personnel with rational pharmacotherapy in resort conditions

The report is dedicated to the new medical technology of sanatorium-resort treatment and metaphylaxis of urolithiasis developed in our resort using Slavyanovskaya mineral water drinking, mineral baths and rational pharmacotherapy (Urolit phytocomplex). Comprehensive SPA therapy of urolithiasis with internal and external (bath) use of Slavyanovskaya mineral water in combination with the Urolit phytocomplex compared to traditional spa treatments contributes to a more pronounced favourable dynamics of the indicators of the functional state of kidneys, correction of metabolic disorders, increased glomerular filtration, increased diuresis and normalization of urodynamics, which are important links in the metaphylaxis of urolithiasis.

MOBILIZATION OF GEORGIA'S NATURAL AND RECREATIONAL RESOURCES UNDER CONDITIONS OF COVID-19 DISSEMINATION: ORGANIZATIONAL AND ECONOMIC ASPECT

The article, through the example of Georgia, examines the problem of efficient using natural-recreational resources in the context of responding to the global challenge of 2020 – COVID-19 pandemic. In difficult conditions, methods are being developed to solve the problems associated with the disease. After acute phase of the disease, patients have to undergo a long-term rehabilitation in order to recover functioning impaired organs and systems of organism. Health-improving practices based on natural-recreational factors would hasten and improve recovery process. Georgia has high potential for the development of the mentioned sphere. For a long time, natural factors of Georgia have been used for therapy, preventive care and rehabilitation of people; there are many world-famous health-resorts in Georgia. The authors propose to use available medical-rehabilitation potential for those who had COVID-19. Positive effect on patients may be made by health-improving measures used in Georgian resorts such as active and passive climatotherapy, air and sun baths, spa treatment, mineral water drinking, bathes, inhalations, mudtherapy, etc. The article analyzes Georgian resorts based on the main medical factors as well as in regional context. Based on the nature of resort resources, regional features and other factors, the territory of Georgia has been divided into 12 resort and recreational areas, differing in their specialization and structure of medical institutions. A summary table contains brief physical-and-geographical characteristics and medical factors of the most popular Georgian resorts along with provided methods of treatment and therapeutic indications. It is emphasized that there is no need to completely reorient existing healthcare facilities, they will be function in the ordinary course, and to serve post-COVID-19 patients special programs will be drawn up. Taking into consideration a great number of COVID-19-patients throughout the world and numerous disease-induced complications, the article proposes to intensify using available natural-recreational potential for rehabilitation purpose and to establish international contacts and experience exchange in this sphere

Медицинская реабилитация при нейропатии лицевого нерва

The purpose — study of the features of medical rehabilitation in neuropathy of the facial nerve. Material and methods. Were studied works on the rehabilitation of patients with facial nerve neuropathy, published in the modern literature. Particular attention was paid to using the methods physiotherapy, therapeutic physical factors, manual therapy, spa treatment, as well as botulinum therapy with this nosology. Results. The main goal of treatment and rehabilitation measures (drug therapy, physiotherapy, acupuncture, massage, post-isometric relaxation of facial muscles and therapeutic gymnastics) for neuropathy of the facial nerve is to provide an anti-inflammatory and dehydrating effect, improve blood and lymph circulation in the nerve, and help improve nerve conduction. Various physiotherapeutic methods are used for anti-inflammatory, absorbable, decongestant, analgesic action in the acute stage of facial nerve neuropathy. Physiotherapy exercises are actively used, which is prescribed for neuropathy of the facial nerve from the acute stage of the disease. In patients with contracture of mimic muscles, post-ismoteric rehabilitation, autorelaxation, performed by the patient after his preliminary training, is successfully used. In the presence of contractures of facial muscles, botulinum therapy is used. Conclusion. Thus, the use of various rehabilitation methods for neuropathy of the facial nerve determines the outcome of the disease, reduces the likelihood of complications, which, in turn, necessitates the use of adequate schemes of combined non-drug treatment for this nosology.

ДИНАМИКА ПРИВЕРЖЕННОСТИ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙ 1-11 СТЕПЕНИ НА ФОНЕ КОМПЛЕКСНОГО САНАТОРНО КУРОРТНОГО ЛЕЧЕНИЯ С ПРИМЕНЕНИЕМ ОБУЧАЮЩИХ ТЕХНОЛОГИЙ В РАМКАХ ШКОЛЫ ЗДОРОВЬЯ «АРТЕРИАЛЬНАЯ ГИПЕРТОНИЯ»

The purpose of the study: to assess the impact of educational activities in the health school "Arterial hypertension" on the immediate and long-term results of treatment in patients with hypertension of I-II degree during the basic Spa treatment. Materials and methods: examination, treatment and dynamic monitoring of 94 patients with arterial hypertension of I-II degree in sanatorium conditions for 21 days was carried out. Patients were randomly divided into the main group and the comparison group. Patients of the main group received basic Spa therapy and studied at the health school "Arterial hypertension". The comparison group received only the basic treatment. Results: the highest increase was found according to the indicator of adherence to medical support, the indicator increased by 32.5 % (p&lt;0.05), and remained consistently high in the catamnesis, after 3 months by 29.8 % (p&lt;0.05), after 6 months by 23.8 % (p&lt;0.05) and after 12 months by 14.4 % (p&lt;0.05). In terms of adherence to lifestyle modification, it significantly increased by 26.7 % (p&lt;0.05), after 3 months by 24.9 % (p&lt;0.05), after 6 months by 19.3 % (p&lt;0.05), and after 12 months by 15.3 % (p&lt;0.05). Adherence to drug therapy significantly increased by 16.9 % (p&lt;0.05) immediately after treatment, after 3 months by 16.2 % (p&lt;0.05), after 6 months by 13.0 % (p&lt;0.05) and after 12 months by 9.0 % (p&lt;0.05). In the main group, after treatment, integral adherence significantly increased by 25.2 % (p&lt;0.05). Patients in the main group maintained a high level of integral adherence throughout the year, besides it was significantly higher than in the comparison group. Conclusion: the inclusion of educational classes at the health school "Arterial hypertension" in the complex Spa treatment of patients with hypertension I-II grade has a statistically significant positive effect on treatment adherence immediately after training, and in the catamnesis after 3, 6 and 12 months.

Assessment of Changes in the Hemoglobin Level under the Influence of Comprehensive Spa Therapy Using Therapeutic Radon-Sulfur Waters and Its Correlation with Free Radical Reactions.

Introduction Hemoglobin is a protein present in erythrocytes of higher organisms. Its main function is to transport oxygen from the lungs to tissues and carbon dioxide from tissues to the lungs. Hemoglobin contains Fe2+, catalyzes free radical reactions, and may initiate oxidation reactions by enzymatic and nonenzymatic degradation. The aim of the study was to evaluate the effect of balneophysiotherapy on the hemoglobin level in osteoarthritis patients and to try to assess the association of those metabolic changes with free radical reactions. Materials and Methods The study was conducted in Przerzeczyn-Zdrój spa resort. It included patients receiving spa treatment over 21-day sessions. The studied group consisted of n = 122 patients with joint and back pain due to osteoarthritis or disc herniation. Their age ranged between 32 and 67 years with a mean age of 53.5. Blood samples were collected before treatment and after 21 days at the spa. Standard tests were used. The results were statistically analyzed using the sign test and the Wilcoxon test. Results In the study group, we observed a drop in the hemoglobin level following spa treatment. Before treatment, the mean hemoglobin level was 14.1549 g%, and after treatment, it was 14.0008 g%. Conclusions (1) In the study, we concluded that balneophysiotherapy in osteoarthritis patients resulted in a decrease in the mean hemoglobin level. (2) The decrease in the mean hemoglobin level in osteoarthritis patients treated at the spa resort may indicate an association with free radical reactions. This trial was registered with NCT03405350.

Socio-economic factors of patients of a military sanatorium in Krynica Zdrój and selected elements of their lifestyle

Introduction: One of the crucial factors influencing the lifestyle and health-related behaviors undertaken by people is their social and economic situation. Apart from material status, the level of education plays a significant role. Social and economic factors are major determinants influencing population health. The socio-economic situation may significantly affect the health-related behaviors undertaken in the group in question. The paper attempts to assess the impact of the socio-economic background of patients with mobility dysfunctions and comorbidities, undergoing the spa and rehabilitation treatment on their health-related behaviors. The study was supposed to answer the question whether undertaking health-related behaviors is dependent on the socio-economic factors of the patients in the study. The study constitutes only one of the elements of broader analysis of health-related behaviors covering patients undergoing sanatorium treatment. Material and methods: The group included in the study consisted of 450 patients (300 women and 150 men) undergoing spa and rehabilitation treatment at the 20 Military Spa and Rehabilitation Hospital in Krynica-Zdrój. Patients were referred to sanatorium treatment mainly due to mobility dysfunctions but also due to comorbidities. Diagnostic survey was used as a research method and the author’s own questionnaire specifically designed for its purpose was applied. The questions concerned physical activity, nutrition, use of psychoactive substances and preventive examinations. The analysis of the patients’ medical documentation provided the authors with objective information about the results of laboratory tests, current health problems and ailments as well as the course of the applied treatment. Research and conclusions: The education level together with economic status of the respondents have a statistically significant impact on the form of selected physical activity in the group under study. Patients with average income went for walks more often while remedial gymnastics was often practiced by patients with monthly net income above PLN 1.500. No statistically significant correlations between the education level and economic status of the patients and the regularity of meals as well as the number of hours devoted to sleep was stated. The correlation between the frequency of stays in sanatorium and the place of residence, education level, type of work performed as well as wealth level was not found.

Effectiveness of Combined Physical Therapy and Balneotherapy Treatment on Knee Osteoarthritis

Amaç: Bu çalışmanın amacı diz osteoartritili hastalarda hot pack (HP), trankütanöz elektriksel sinir stimülasyonu (TENS) ve kısa dalga diatermi (KDD)’den oluşan fizik tedavi ile kombine kaplıca tedavisinin sadece fizik tedaviye göre ağrı, tutukluk ve fonksiyonel durum üzerine etkisini araştırmaktır.Gereç ve Yöntemler: Diz osteoartriti olan 32 hastanın (Grup 1: fizik tedavi+kaplıca tedavisi alan hastalar) ve 31 hastanın (Grup 2: fizik tedavi alan hastalar ) tedavi öncesi (0.gün) ve tedavi sonrası (10.gün) Western Ontario and McMaster Universities Arthritis Index (WOMAC) ağrı, WOMAC tutukluk, WOMAC fonksiyonel durum ve WOMAC toplam skorları değerlendirildi.Bulgular: Tedavi sonrası WOMAC ağrı, WOMAC tutukluk, WOMAC fonksiyonel durum ve WOMAC toplam skorlarında tedavi öncesi değerlere göre her iki grupta da istatistiksel olarak anlamlı gelişme saptandı (p&amp;lt;0.001). Ancak tedavi sonuçları arasında gruplar arası istatistiki olarak anlamlı fark saptanmadı.Sonuç: Diz osteoartritli hastalarda hem HP, TENS ve KDD’den oluşan fizik tedavi hem de fizik tedavi ile kombine kaplıca tedavisi ağrı, tutukluk ve fonksiyonel durum üzerine etkilidir. Ancak iki tedavi grubunun birbirine üstünlüğü saptanmamıştır.

PERFORMANCE STANDARD OF SPA SERVICES WITH THE JAVANESE MASSAGE METHODIN THE ACADEMY OF SOCIAL PROSPERITY "AKK" OF YOGYAKARTA

Spa is a beauty treatment that not only refreshes and calms the mind. But it also has several healthbenefits. Thispaper discussed the implementation of Spa services refer to the Operational Service Standards (SOP) which will be the main force. The role of the government through four departments, in collaboration with the Indonesian Spa Association together to form Business Standards, Services, National Work Competency Standards (SKKNI), Curriculum Standardization with the Ministry of Education, and Promotion Cooperation Standards withthe Ministry of Tourism.According to the SKKNI employment in the Spa field refers to knowledge, skills, attitudes. The concept of service at Spa refers to excellent service to foster trust in customers. Excellent service must be supported by quality human resources that are reliable, have a vision that is far ahead and can develop strategies and tips for excellent service that has excellence.The Javanese Massage method applies a combination of several body treatments that originate from cultural and technological traditions, with Javanese sorting methods. It is beneficial for the muscles and can be effective in blood circulation, relieving muscle tension, stimulating the rhythmic nerves to achieve a sedative effect, stimulating and calming. In the Spa treatment, there are various body treatments, namely body scrubs, body massages, body masks and aroma therapy.

THE INTRODUCTION OF INNOVATIVE CONCEPTS IN THE MANAGEMENT SYSTEM OF THE SANATORIUM-RESORT ENTERPRISE IN THE CONTEXT OF ENSURING SOCIO-ECONOMIC SECURITY

. Goal. Coverage of introduction of innovative concepts in the system of management of activity of sanatorium and resort enterprises. Research methodology. The following methods were used: analysis (theoretical review of scientific literature on the problem of research); a synthesis that made it possible to integrate individual parts of the facility into a single unit (development of a Balanced Scorecard for health resort enterprises in terms of socio-economic security); benchmarking that allowed us to map concepts (spa marketing, business performance management, and balanced scorecard). Results. The peculiarities of the management system of the sanatorium and resort enterprises in the conditions of social and economic security are considered. It is stated that the concept of management in terms of ensuring the socio-economic security of any enterprise of the sanatorium and resort complex is based on clearly formed systems of organization of management of socio-economic development. The basic methods of implementation, organization and management of social and economic security at the enterprise are distinguished. It is noted that spa marketing is a concept of management of the spa enterprise, which provides a comprehensive study of the needs of clients in the spa treatment and recreation for their fullest satisfaction through complex efforts to produce, sell and promote the spa product in a competitive market with the aim ensuring socio-economic security and profit. The basic processes covered by the concept of Business Performance Management for spa companies are presented. The Balanced Scorecard Balance Scorecard system has been developed for sanatorium and resort enterprises in terms of social and economic security. Scientific novelty. The basic innovative concepts (spa marketing, Business Performance Management and Balanced Scorecard) are proposed, which introduction into the enterprise management system will ensure effective management decisions, achievement of strategic goals, increase of profit and social and economic security in general. Practical importance. The introduction of our proposed concepts into the management system of sanatorium and resort enterprises will provide such an institution with a complete and effective implementation of processes for managing its activities, providing customer service and optimizing the functions and management procedures performed.

Legal support for the use of natural therapeutic resources in sanatorium and resort treatment of the population

The aim. To conduct a comprehensive study of the legal regulation peculiarities of natural therapeutic resources and factors of sanatorium and resort treatment for the population, to identify problems of legal regulation of these relations and to outline the ways to resolve them. Materials and methods. The research material is a modern regulatory framework. The methods of information retrieval, analysis, systematization and generalization were carried out. Results. It has been established that natural therapeutic resources include mineral and thermal water, medical mud and ozokerite, sea and lake brine, sea water, natural objects and complexes with favorable climatic conditions. It has been substantiated that sanatorium and spa treatment is an important part that provides continuity and complexity of medical rehabilitation measures. The main resorts, located on theterritory ofUkraine, have been described. It has been determined that regulation of social relations in the sphere of organization and development of resorts and sanatorium-resort treatment, detection and accounting of natural medical resources, ensuring their rational extraction, use and protection in order to create favorable conditions for treatment, medical rehabilitation, prevention of diseases and vacation for people is provided by environmental, land, health care and resort legislation. Conclusions. Legal regulation of the natural therapeutic resources usage is ensured by environmental, land, health care and resort legislation. The purpose of this legislation is to regulate social relations in the sphere of organization and development of resorts and sanatorium and spa treatment, to detect and account natural medical resources, to ensure their rational extraction, use and protection in order to create favorable conditions for treatment, medical rehabilitation, prevention of diseases and population health improvement. Efficient exploitation of natural therapeutic resources in resort treatment is currently affected by a number of economic, political, environmental problems, which have to be solved by organizational and legal means of the state impact on such legal relations.

КУРОРТНИЙ ПОТЕНЦІАЛ МЕДИЧНОЇ РЕАБІЛІТАЦІЇ: СТРАТЕГІЧНИЙ ПРІОРИТЕТ ДЕРЖАВНИХ ІНВЕСТИЦІЙ

The article, on the basis of the analysis of the current state of sanatorium and resort complex development (on the example of the Odessa oblast), substantiates the priorities of state investment into the development of medical rehabilitation at resorts (in the system of sanatorium and spa treatment). It is established that one of the most promising tourist and recreation centers in the Odessa region is the southwest coast of the Black Sea. In the seaside lane of the Odessa oblast there is a developed network of resort establishments (sanatoriums, sanatoriums-preventive hospitals, houses, boarding houses and recreation centers). To determine the strategic priorities of state investment in the resort sphere of the Odessa oblast, the territories most promising for spa and wellness and recreational development have been allocated, taking into account the rational use of natural healing resources and the potential of the resort and recreational infrastructure of the Odessa oblast. According to the current state of organization of the sanatorium and resort complex and resort-recreational activities in the seaside lane of the Odessa oblast the most attractive for investment are: territories with developed resort and recreational infrastructure: resort «Kuialnyk», resort «Serhiivka», recreation and health improvement zone «Zatoka», resort «Odesa-Center»; areas promising for the development of sanatorium and recreational, recreation and health improvement activities: Sasyksko-Shahanska area - between Lake Shahany and Lake Sasyk along the lagoons of Mali Sasyk and Dzhantshei. On the lands of Tuzlivska, Lymanska, Prymorska settlement councils of Tatarbunarskyi rayon; Kuialnytsko-Tylihulska area - is located between the left bank of the Kuialnytskyi estuary near the village. Krasnosilka along the Black Sea coast to the right bank of the Tylihulskyi estuary within the administrative boundaries of the Lymanskyi rayon of Odesa oblast. Within the area there are also the Small and Large Adzhalytskyi estuaries. It is proved that involvement in the sanatorium and resort industry of investments is the most urgent issue in the aspect of infrastructural development of medical rehabilitation. health resort institutions are the main objects of the resort and recreation infrastructure for the provision of sanatorium and resort, rehabilitation, wellness, tourist and other services. The organization of medical rehabilitation on the basis of health resort institutions provides a competitive advantage and additional investment attractiveness of the resort. It is determined that the investments can be aimed at modernization of existing or creation of new health resorts, organization on the basis of sanatoriums of rehabilitation wards, expansion and development of their medical base, modern high-tech rehabilitation equipment, scientific development of new rehabilitation technologies using natural healing resources, etc. The following prerequisites for the investment attractiveness of the development of the medical rehabilitation system at resorts are defined: the development of medical rehabilitation in health resort institutions is provided with regulatory legal regulation, the organization of medical rehabilitation in sanatoriums is defined at the legislative level; The Ministry of Health of Ukraine has developed the concept of reforming the rehabilitation system in Ukraine: the introduction of the International Classification of Functioning and the training of rehabilitation doctors; the project «Rehabilitation Map of Ukraine» has been launched; the process of inventorying the state of natural healing resources and obtaining the resort status by the respective territories is being implemented. It is emphasized that sanatorium and resort complexes at resorts should be the first investment objects, in particular investments should be directed to the modernization of sanatorium establishments and promotion of brand and rehabilitation services.

Stress management in obesity during a thermal spa residential programme (ObesiStress): protocol for a randomised controlled trial study

IntroductionStress and obesity are two public health issues. The relationship between obesity and stress is biological through the actions of stress on the major hormones that regulate appetite (leptin and...

Spa therapy induces clinical improvement and protein changes in patients with chronic back pain.

This study is primarily aimed at assessing serum changes on a large panel of proteins in patients with chronic back pain following spa therapy, as well as evaluating different spa therapy regimens as a preliminary exploratory clinical study. Sixty-six patients with chronic back pain secondary to osteoarthritis were randomly enrolled and treated with daily mud packs and bicarbonate-alkaline mineral water baths, or a thermal hydrotherapy rehabilitation scheme, the combination of the two regimens or usual medication only (control group), for two weeks. Clinical variables were evaluated at baseline, after 2 and 12 weeks. One thousand serum proteins were tested before and after a two-week mud bath therapy. All spa treatment groups showed clinical benefit as determined by improvements in VAS pain, Roland Morris disability questionnaire and neck disability index at both time points. The following serum proteins were found greatly increased (≥2.5 fold) after spa treatment: inhibin beta A subunit (INHBA), activin A receptor type 2B (ACVR2B), angiopoietin-1 (ANGPT1), beta-2-microglobulin (B2M), growth differentiation factor 10 (GDF10), C-X-C motif chemokine ligand 5 (CXCL5), fibroblast growth factor 2 (FGF2), fibroblast growth factor 12 (FGF12), oxidized low density lipoprotein receptor 1 (OLR1), matrix metallopeptidase 13 (MMP13). Three proteins were found greatly decreased (≤0.65 fold): apolipoprotein C-III (Apoc3), interleukin 23 alpha subunit p19 (IL23A) and syndecan-1 (SDC1). Spa therapy was confirmed as beneficial for chronic back pain and proved to induce changes in proteins involved in functions such as gene expression modulation, differentiation, angiogenesis, tissue repair, acute and chronic inflammatory response.

Quality of life in spondyloarthritis patients receiving biological therapy

Spondyloarthritides (SpAs) is a group of chronic inflammatory diseases of the spine, joints, and entheses characterized by common clinical, radiological, and genetic features. According to international guidelines, one of the main goals of SpA treatment is to ensure the longest possible preservation of the patient's quality of life (QOL). The use of biological agents (BAs) allows rapid clinical improvement and positively affects QOL in patients.Objective: to evaluate the efficacy of BAs on QOL in patients with SpA in real clinical practice.Patients and methods. A total of 280 patients with SpA were examined. The inclusion criteria were ≥18 years of age; compliance of the clinical picture of the disease with the ASAS criteria for axial SpA (2009) or peripheral SpA (2011); and signing the informed consent form. Disease activity was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Ankylosing Spondylitis Disease Activity Score (ASDAS); the functional status of the patients was estimated by the Bath Ankylosing Spondylitis Functional Index (BASFI), and their spinal mobility was evaluated by the Bath Ankylosing Spondylitis Metrology Index (BASMI); ASAS HI was used to comprehensively evaluate the impact of SpA on the patient's health. The European QL EQ-5D-5L and the SF-36 questionnaire were applied to determine quality of life in the patients.Results and discussion. The patients' mean age was 40.19±11.9 years; there was a male preponderance (64%); the HLA-B7-pisitive patients were 78%. The median scores were 5.40 [3.12; 6.80] for BASDAI, 3.37 [2.58; 4.15] for ASDAS, 5.30 [2.60; 7.50] for BASFI, 4.00 [2.60; 6.15] for BASMI, and 9.00 [7.00; 12.00] for ASAS HI. Forty-four patients received a variety of BAs. Patients receiving and not receiving BAs were matched for age and gender; however, the patients on biological therapy (BT) had longer disease duration and lower disease activity according to the ASDAS. There were no statistically significantly difference between the two groups in disease activity according to the BASDAI and in functional disorders according to the BASFI; but there was a tendency towards lower values in the patients on BT. Comparison of QOL in the patients of the two groups revealed statistically significant differences in SF-36 pain scale scores (p=0.02) and EQ-5D-5L indicators (p&lt;0.01).Conclusion. BT makes it possible to successfully achieve one of the main goals of treating patients with SpA, namely to preserve QOL. The patients receiving BAs had longer disease duration, while they were comparable to those not receiving this treatment in terms of the degree of functional disorders.

Spa Society in Russian Literature, 1829–1912

Abstract The article explores the dichotomy between nineteenth-century Russian writers’ personal experiences at spas and their literary descriptions of them. In private correspondence, authors praised the effect of spa treatments on their health, and they returned year after year to these locations of leisure, calling them ‘beautiful’ or ‘charming’. Yet in their fiction and essays they were sarcastic, if not downright negative about their stays at spas. The keys to understanding such a contradiction appear to be the commercialization of fashionable spas over the course of the nineteenth century; the evolution of a system of shared social values in Russia; and the way Russian writers increasingly perceived literature as a duty towards society.

Effects of a short residential thermal spa program to prevent work-related stress/burnout on stress biomarkers: the ThermStress proof of concept study.

ObjectiveWork-related stress is a public health issue. Stress has multiple physical and psychological consequences, the most serious of which are increased mortality and cardiovascular morbidity. The ThermStress protocol was designed to offer a short residential thermal spa program for work-related stress prevention that is compatible with a professional context.MethodsParticipants will be 56 male and female workers aged 18 years or above. All participants will undergo a 6-day residential spa program comprising psychological intervention, physical activity, thermal spa treatment, health education, eating disorder therapy and a follow-up. On six occasions, participants’ heart rate variability, cardiac remodelling and function, electrodermal activity, blood markers, anthropometry and body composition, psychology and quality of life will be measured using questionnaires and bone parameters.ResultsThis study protocol reports the planned and ongoing research for this intervention.DiscussionThe ThermStress protocol has been approved by an institutional ethics committee (ANSM: 2016 A02082 49). It is expected that this proof of concept study will highlight the effect of a short-term specific residential thermal spa program on the prevention of occupational burnout and work-related stress. The findings will be disseminated at several research conferences and in published articles in peer-reviewed journals.Trial Registration: ClinicalTrials.gov (NCT 03536624, 24/05/2018)

PENGARUH BABY SPA TERHADAP PERKEMBANGAN BAYI USIA 3-9 BULAN DI PUSKESMAS SOCAH BANGKALAN

Development is important for the child'sdevelopment phase. In the preliminary study,60% of 3-9 months infants experienceddevelopmental delays. The purpose of thestudy was to analyze the differences in thedevelopment of infants aged 3-9 monthsbefore the baby spa was conducted with thebaby spa at the Puskesmas SocahBangkalan. The study design used Pre Experimentalwith the approach of one group pretestposttest.&#x0D; The dependent variable is thedevelopment of infants aged 3-9 months andthe independent variable is baby spa. Thepopulation of all infants aged 3-9 months whowere not sick was 25 infants with a sample of16 infants grouped into one group and carriedout baby spa treatment, with a purposivesampling technique. The instruments usedKPSP sheets were then analyzed usingunivariate analysis using the Paired SampleT-Test statistical test. Based on the results of a study beforebaby spa that most babies (62.4%) haddeveloped doubts as many as 10 babies.while after baby spa (50%) babies developdubious development and (50%) theremaining babies develop accordingly, namely8 babies, Statistical test results with PairedSamples developmental T-Test for infantsaged 3-9 months before and after baby spa pValue (0,000) &lt;α (0.05) means that there is adifference in the development of infants aged3-9 months before and after the baby spa. We recommend that health workers canalso do baby spa because baby spa is verybeneficial for children's development.&#x0D;

Activation of Adrenal Steroidogenesis and an Improvement of Mood Balance in Postmenopausal Females after Spa Treatment Based on Physical Activity.

Spa treatment can effectively reestablish mood balance in patients with psychiatric disorders. In light of the adrenal gland’s role as a crossroad of psychosomatic medicine, this study evaluated changes in 88 circulating steroids and their relationships with a consolidation of somatic, psychosomatic and psychiatric components from a modified N-5 neurotic questionnaire in 46 postmenopausal 50+ women with anxiety-depressive complaints. The patients underwent a standardized one-month intervention therapy with physical activity and an optimized daily regimen in a spa in the Czech Republic. All participants were on medication with selective serotonin reuptake inhibitors. An increase of adrenal steroidogenesis after intervention indicated a reinstatement of the hypothalamic-pituitary-adrenal axis. The increases of many of these steroids were likely beneficial to patients, including immunoprotective adrenal androgens and their metabolites, neuroactive steroids that stimulate mental activity but protect from excitotoxicity, steroids that suppress pain perception and fear, steroids that consolidate insulin secretion, and steroids that improve xenobiotic clearance. The positive associations between the initial values of neurotic symptoms and their declines after the intervention, as well as between initial adrenal activity and the decline of neurotic symptoms, indicate that neurotic impairment may be alleviated by such therapy provided that the initial adrenal activity is not seriously disrupted.