Pedro Cantista

A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology

Health Resort Medicine, Balneology, Medical Hydrology and Climatology are not fully recognised as independent medical specialties at a global international level. Analysing the reasons, we can identify both external (from outside the field) and internal (from inside the field) factors. External arguments include, e.g. the lack of scientific evidence, the fact that Balneotherapy and Climatotherapy is not used in all countries, and the fact that Health Resort Medicine, Balneology, Medical Hydrology and Climatology focus only on single methods and do not have a comprehensive concept. Implicit barriers are the lack of international accepted terms in the field, the restriction of being allowed to practice the activities only in specific settings, and the trend to use Balneotherapy mainly for wellness concepts. Especially the implicit barriers should be subject to intense discussions among scientists and specialists. This paper suggests one option to tackle the problem of implicit barriers by making a proposal for a structure and description of the medical field, and to provide some commonly acceptable descriptions of content and terminology. The medical area can be defined as “medicine in health resorts” (or “health resort medicine”). Health resort medicine includes “all medical activities originated and derived in health resorts based on scientific evidence aiming at health promotion, prevention, therapy and rehabilitation”. Core elements of health resort interventions in health resorts are balneotherapy, hydrotherapy, and climatotherapy. Health resort medicine can be used for health promotion, prevention, treatment, and rehabilitation. The use of natural mineral waters, gases and peloids in many countries is called balneotherapy, but other (equivalent) terms exist. Substances used for balneotherapy are medical mineral waters, medical peloids, and natural gases (bathing, drinking, inhalation, etc.). The use of plain water (tap water) for therapy is called hydrotherapy, and the use of climatic factors for therapy is called climatotherapy. Reflecting the effects of health resort medicine, it is important to take other environmental factors into account. These can be classified within the framework of the ICF (International Classification of Functioning, Disability and Health). Examples include receiving health care by specialised doctors, being well educated (ICF-domain: e355), having an environment supporting social contacts (family, peer groups) (cf. ICF-domains: d740, d760), facilities for recreation, cultural activities, leisure and sports (cf. ICF-domain: d920), access to a health-promoting atmosphere and an environment close to nature (cf. ICF-domain: e210). The scientific field dealing with health resort medicine is called health resort sciences. It includes the medical sciences, psychology, social sciences, technical sciences, chemistry, physics, geography, jurisprudence, etc. Finally, this paper proposes a systematic international discussion of descriptions in the field of Health Resort Medicine, Balneology, Medical Hydrology and Climatology, and discusses short descriptive terms with the goal of achieving internationally accepted distinct terms. This task should be done via a structured consensus process and is of major importance for the publication of scientific results as well as for systematic reviews and meta-analyses.

The role of land and aquatic exercise in ankylosing spondylitis: a systematic review

Ankylosing spondylitis (AS) is a chronic and inflammatory rheumatic disease, characterized by pain and structural and functional impairments, such as reduced mobility and axial deformity, which lead to diminished quality of life. Its treatment includes not only drugs, but also nonpharmacological therapy. Exercise appears to be a promising modality. The aim of this study is to review the current evidence and evaluate the role of exercise either on land or in water for the management of patients with AS in the biological era. Systematic review of the literature published until November 2016 in Medline, Embase, Cochrane Library, Web of Science and Scopus databases. Thirty-five studies were included for further analysis (30 concerning land exercise and 5 concerning water exercise; combined or not with biological drugs), comprising a total of 2515 patients. Most studies showed a positive effect of exercise on Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, pain, mobility, function and quality of life. The benefit was statistically significant in randomized controlled trials. Results support a multimodal approach, including educational sessions and maintaining home-based program. This study highlights the important role of exercise in management of AS, therefore it should be encouraged and individually prescribed. More studies with good methodological quality are needed to strengthen the results and to define the specific characteristics of exercise programs that determine better results.

Ultrasonography as an Evaluation Tool in a Randomized Controlled Trial Assessing Balneotherapy Effects in Rheumatoid Arthritis

Objective: To evaluate the usefulness of ultrasonography as an evaluation tool in a Randomized Controlled Trial assessing Balneotherapy effects in Rheumatoid Arthritis. Methods: A prospective controlled clinical trial, not blinded, randomly assigned of patients with rheumatoid arthritis accordingly to the American College of Rheumatology criteria. The Balneotherapy group received Balneotherapy’s throughout 21 days in S. Jorge Spa. The main outcome was hand/wrist ultrasonography measured at the same moments in the two groups, and McNemar’s tests were used to compare changes in ecographics signals, with a 5% statistical significance level. Secondary outcomes were taken at same time for HAQ-DI and DAS28. A moderated regression analysis, complemented with the Johnson-Neyman (J-N) technique was used to perform the statistical analysis. Results: In thermal group there was a statistically significant result (p < 0.05) regarding the evolution of synovitis only at left hand/wrist according to ultrasonography signals, between baseline and day 21, end of thermal treatment, and after 3 months. Curiously, the same statistical findings were found in the control group, but at right side. No difference was found in DAS28 at the end of Balneotherapy but almost reach significance at month 3. HAQ-DI at end of treatment and 3rd month follow-up was significantly improved in the Balneotherapy. Conclusions: Pain and diminished function are hallmarks of RA patients, so any complementary contribution with no or mild side effects, as Balneotherapy, is welcome to enhance quality of life. In this study ultrasonography could detect improvement in synovitis in both RA patients groups, Balneotherapy translating both the possible effect of treatment and the natural history of RA. Both joints were the more affected at enrolment and the Balneotherapy had a slightly higher DAS28. Quality of life had a sustainable improvement with Balneotherapy. Ultrasonography is an objective, inexpensive modality to measure the response of RA small joint synovitis to Balneotherapy, provided that it is realized by a medical doctor with specific formation.

Epidemiology: The Most Frequent Lesions

Epidemiological studies on football injuries have been implemented in Europe since the end of the 1970s. Simultaneously, prevention programmes were implemented to avoid injuries regarding muscle, tendon and ligament severe injuries. The analysis of injury incidence and the improvement of prevention strategies played a role in injury incidence decrease. However, the analysis of the congested match calendar must go on in order to decrease the risk of injury and, mostly, reinjury incidence.