POSTERS PAPERS DAY 1 POSTERS SESSION 8.30 am – 10 am Biology, physiology, epidemiology P1 Hydrotherapy : kinematic characteristics of aquatic gait in patients with spinal injury Israel Vera Lúcia1, Iucksch Dielise Debona2, Manffra Elisabela Ferretti3 [Brazil] 1 - Professor at UFPR – Setor Litoral, Brasil, research counselor in charge of the paper presentation in the ISMH 2010 event 2 - Physical therapist in the Ana Carolina Moura Xavier Hospital Rehabilitation Center, researcher and author in charge of the paper development in the Graduate Program on Health Technology (PPGTS) at PUCPR 3 - Professor in the PPGTS at PUCPR, research paper co-counselor Israel Vera Lúcia Rua Jaguariaiva, 512 83260000 Matinhos Paraná (BR) +55 (41) 9962-2163 veral.israel@gmail.com Introduction The motor strategies adopted to walking in the aquatic environment depend upon the adaptation of the sensory-motor system responses to an environment whose physical characteristics are different from those of the land environment. Such characteristics of the aquatic environment can be used in the rehabilitation of people with spinal cord injury (SCI). According to the literature, people with SCI who were not capable of standing up straight without support on land, managed to even perform gait in the pool. In hydrotherapy with spinal cord injured patients, it is common to use distinct strategies in the training of motor skills such as gait and balance, thus enhancing the person´s motor control and confidence. Therefore, in the first sessions ortheses may be used [Israel, 1999], as well as bars that provide support or the hands of the physical therapist and, as functional recovery and adaptation progresses in patients with SCI, it is even possible to progressively remove such support. The gait phenomenon in the heated pool aquatic environment can have specific characteristics, therefore the purpose of this trial was: to verify linear kinematic characteristics of stride length and aquatic gait cadence in spinal cord injured patients. Methodology Nine people with incomplete SCI (39±14.2 years, 67±9.5 kg and 1.70±0,07 m), ASIA C (n=2) e D (n=7), only one of whom could walk independently on land, deambulated in the water with markers on the following anatomical points: head of the fifth metatarsus, lateral malleolus, femoral condyle, greater trochanter of the femur and tenth rib in the inferior vertical projection of the axillary line (approved by the Ethics Committee on Research at the Pontifícia Universidade Católica do Paraná 1400/08). The participants walked with the support of the researcher´s hands while they were filmed in the right sagittal plane. Eight individuals managed to deambulate with no hand support, however the data for one of them could not be assessed because the foot markers were concealed. The images were analysed with the SIMIMotion software and the position of the markers were manually recovered in each frame of the gait cycle. The data for the seven individuals who had valid strides in the two conditions were then compared. Results The mean value of stride length with and without support were, respectively, 0.337 m (±0.119) and 0.332 m (±0.156) and the mean cadence was 30.77 (±7.68) strides/minute with support and 30.35 (±11.84) strides/minute without support. Using ANOVA it was possible to verify that there is no statistically significant difference (p>0.05) between the cycle performed with and without the support of the researcher’s hands on the hands of the individuals. Conclusions Out of the nine participants in the trial, eight managed to successfully deambulate without support in the aquatic environment, probably due to the support provided by the physical properties of water, especially the principles of Archimedes, Reynolds´ (in gait) and Pascal (in balance), having facilitated the functional movement necessary for aquatic gait to be performed. Moreover, in the situations provided by this trial, it could be observed that the gait conducted with the support on the hands of people with SCI, commonly used in clinical practice in early hydrotherapy, could be done with no significant alteration of the linear characteristics analysed of stride length and gait cadence. Keywords : Hydrotherapy, Aquatic Physical Therapy, Spinal Cord Injury, Gait, Kinematic P2 Hydrotherapy : evaluation of arterial pressure in Parkinson’s disease patients who are considered to be in middle stages in their disease development and who have undergone Halliwick Concept treatment Gnoato TG1, Loureiro APC¹, Viana JFR¹, Sabino J¹, Silva LPAC¹, Cruz LGF¹, Israel VL² [Brazil]
 1 - Pontifícia Universidade Católica do Paraná – PUCPR - Curitiba   
 2 - Universidade Federal do Paraná –UFPR/Litoral - Matinhos Israel Vera Lúcia Rua Jaguariaiva, 512 83260000 Matinhos – Paraná (BR) anna.loureiro@gmail.com Introduction The occurrence of involuntary phenomena in Parkinson’s disease (PD) has long been documented in their vasomotor disturbances, which manifest and directly affect functional lives of the patients. An effective hydrotherapy can promote muscular relaxation ; vasodilation and can also stimulate and influence factors that control the arterial pressure. Objective To verify the effects of hydrotherapy in warm water on the arterial pressure among middle-stage PD patients after having undergone Halliwick Concept treatment. Material and Methods Seven PD patients (age range 59.85±7.92 years old) in second stage according to the Hoehn and Yahr Scale (time of lesion 7.85±3.80 years) participated in this study. Clinical as well as functional and qualitative approaches were used to collect arterial pressure measurements using analog sphygmomanometers at the beginning and end of each intervention. Ten therapeutic interventions, each lasting 60 minutes per session in a warm swimming pool (approximately between 33ºC and 34ºC), were given in groups following the Halliwick Concept treatment, which aim at the development of aquatic abilities, as well as the socialization and well-being of these participants. Results The Wilcoxon statistical analysis was performed on the measurements of the systolic arterial pressure (p=0.3) and diastolic arterial pressure (p=0.2), collected at the beginning and end of each intervention. Conclusion Obtained results at the conclusion of this research demonstrated that the participants did not have statistically significant alterations in their arterial pressures. There are innumerable unlinked physical properties that act on the immersed body in the water, such as stimulation of the peripheral circulation. It is possible that the quantity of the interventions or the number of samples was not sufficient for significant enough changes in the arterial pressures of the participants. P3 A study of thermal effects by concentration of sodium chloride Masaharu Maeda, Hirotaka Nagumo, Masaru Ichikawa, Hara Mariko, Nao Wada, Yoshimi Sakurai, Kazumi Fujita [Japan] International University of Health & Welfare graduate school Maeda Masaharu 2600-1 Kitakanemaru 324-8501 Otawara-city (JP) +81287243016 / +81-9080008207 mm@iuhw.ac.jp Purpose Many hot springs in Japan contain sodium chloride, and there are even some that have the same or more concentration than seawater (around 4 % density). Hot springs containing sodium chloride are known to possess high thermal effects. It warms the body when bathed in this hot spring, and the warmth retaining effect continues long after bathing. It is possible to use this thermal effect for balneological treatment. However, basic research on concentration of this hot springs is still limited and differences in thermal effects between different concentrations are unclear. So in order to determine the effective concentration for thermal treatment, we measured the changes in body temperature with different densities of sodium chloride water. Subjects 10 healthy adults (4 males, 6 females. Age : 20.7±0.7 years) Methods After rest sitting position for 5 minutes for measurement, each subject bathed in a bathtub with 200 liters water at 41℃ for 15 minutes. Changes in blood pressure, pulse rate, deep body thermometer and surface skin blood flow at thigh were measured, while rest sitting position without keeping warm with towels and clothes. We dissolved 0.1, 1.0, 2.0, and 4.0 % sodium chloride in tap water and compared with tap water bathing. Each data was taken with more than one or more days in between，and at random order of concentrations. Results Decrease of systolic pressure was 25 mmHg and diastolic pressure 35mmHg during the bathing. Then they went back to normal pressure soon after the bathing. The pulse rate increased by about 20, but there were no differences between concentrations. Increase in deep body thermometer measured 15 minutes after bathing was 0.9℃ in tap water, 1.1℃ with 0.1% sodium chloride, 1.1℃ with 1.0 %, 1.4℃ with 2.0 % and 1.7℃ with 4.0 %, so the temperature increased according to the increase of concentration. The body temperature 30 minutes after bathing was 0.5℃ in tap water, 0.6℃ with 0.1% sodium chloride, 0.6℃ with 1.0%, 1.0℃ with 2.0% and 1.1℃ with 4.0 %, so significant differences were measured with concentration over 2.0 %. There were no remarkable differences in surface skin blood flow at thigh. 9.4 ml/min/100 tissue in tap water, 11.2 ml/min/100 tissue with 0.1 ％ sodium chloride, 12.8 ml/min/100 tissue with 1.0 ％, 10.3 ml/min/100 tissue with 2.0 ％, 12.6 ml/min/100 tissue with 4.0 ％. Discussion and conclusion For blood pressure decrease and pulse rate increase, hot water containing sodium chloride is considered to have the same effects as tap water, and therefore have no remarkable effect in cardiovascular system. Deep body thermometer increases according to the concentration of sodium chloride, but by looking at the results in surface skin blood flow at thigh, we can see that the effect was not caused by vasodilating effect. From the deep body thermometer rise we can observe that the body temperature rises according to concentration rise. This is thought to be caused by differences in thermal energy per unit volume in sodium chloride hot water. The water would have more heating value with higher concentration, and therefore it would transfer more heat to the body. Moreover, looking at the results in deep body thermometer rise in different concentrations, we found that there were thermal effects that cause body temperature rise and warmth retaining effect in sodium chloride hot water with over 2 % density. So, we can say that 2 % is the effective density for thermal treatment. P4 The role of humic and fatty acids on cooling rates of different therapeutic mud species Odabasi Ersin1, Turan Mustafa1, Tekbas Faruk2 [Turkey] 1 - Gulhane School of Medicine, Department of Medical Ecology and Hydroclimatology, Ankara 2 - Gulhane School of Medicine, Department of Public Health, Ankara 
 Odabasi Ersin Gulhane School of Medicine, Department of Medical Ecology and Hydroclimatology, Ankara, Turkey 06018 Ankara (TR) ersinodabasi@hotmail.com Objective It is suggested that chemical properties, especially organic constituents, affects the thermal behaviour of the mud. Structural components and how they contribute to the thermal behaviour of mud has not been revealed. It is known that mud contains free fatty acids (FA) besides humic acid (HA) derivates. Current study is aimed to define how HA and FA affects cooling rates of various kinds of mud packs. Methods Three different kinds of therapeutic mud were included in the study. Using different concentrations of FA or HA 8 sets of mud packs were prepared for each mud type : pure, containing FA in 1 %, 2 %, 3 % concentrations, containing HA in 1 %, 2 %, 3 % concentrations, and containing both FA and HA in 3% concentration (w/w). All packs were heated up to 47°C and left to cool at the room temperature. As the temperature of mud-pack decreased to 45°C, the cooling period was started to record for 30 minutes. Results Cooling periods of pure forms of mud types differed significantly from each other at the 30th min. ; torf mud kept its’ temperature longer. The cooling period was found to be significantly longer in samples of mud containing HA and/or FA as compared to their pure forms (p<0.05). The most significant delay was observed in thermal spring mud. Conclusions The cooling rate of mud is closely related to its’ chemical compositions. HA and FA are seem to be the components that affect cooling rate most strikingly. P5 Skin response to osmotic cosmetics elaborated with mud made from chlorided ferruginous mineral water Carbajo José-Manuel1-3, L Delgado MI3, Armijo F1-2, Maraver Francisco1-2-3 [Spain] 1 - Chair of Medical Hydrology, School of Medicine, UCM, Madrid 2 - Physical Medicine and Rehabilitation. Medical Hydrology Department, School of Medicine, UCM, Madrid 3 – Lanjarón Spa, Granada Carbajo José Manuel Chair of Medical Hydrology – School of Medicine, UCM 28040 Madrid (ES) hidromed@med.ucm.es 
 Introduction The human skin’s biophysical characteristics in vivo constitute an important indicator of the skin’s condition. Non invasive methods of exploration (MENI) used to evaluate give a direct measure of the biophysical characteristics of this organ and have the possibility of skin condition quantification. Objectives The study was designed to distinguish the skin response after the continuous application (three months) of two different osmotic cosmetics: a Moisturizing Emulsion and a Facial Mask, both elaborated from Lanjarón-Capuchina mineral water “dry residue : 19.871 mg/L ; chloride (Cl-) : 8.867 mg/L ; sodium (Na2+) : 3.941 mg/L ; calcium (Ca2+) : 1.423 mg/L ; magnesium (Mg2+) : 235 mg/L ; sulphate (SO42-) : 448 mg/L ; bicarbonate (CO3H1-) : 1.732 mg/L and iron (Fe2+) : 28 mg/L”. Method The biological response was registered by means of five non invasive techniques : Cutometer, Sebumeter, pH-meter, Reviscometer and Tewameter (TEWL). Results The results suggest that skin response may be modified and/or controlled, significantly reducing skin sebum (6 %), TEWL (21 %) and skin fatigue due to repeted suction (30 %) after 15 days of treatment and stabilized after approximately 60 days. On the other hand, a considerable increase of total skin elasticity Ua/Uf (19 %), skin resistance to maximum extension Uf (5 %), and dermal redensification evaluated by means of the Reviscometer (6 %) was observed. The pH and cutaneous viscoelasticity (Uv/Ue) determinations have resulted irrelevant and not significant. Key words : chlorided-ferruginous mineral water, mud, osmotic cosmetic, skin, in vivo, non-invasive methods P6 Fine water droplets in air by electrostatic atomization improve chronic pain sensation thresholds and autonomic nerve functions Watanabe Ichiro1, Nagato Itsuki1, Sugo Maiko1, Watanabe Tomoko1, Yamauchi Toshiyuki2, Tatsuta Mika3, Iwakawa Mikio2 [Japan] 1 - Aomori University of Health and Welfare Graduate School of Rehabilitation and Welfare engineering
 2 - Panasonic Electric Works Co.Ltd. 3 - Panasonic Electric Works Analysis Center, Co.Ltd.
 Watanabe Ichiro Hamadate Mase 58-1 030-8505 Aomori (JP) +81-17-765-2084 / +81-17-765-2084 i_watanabe@auhw.ac.jp Aim Negative air ions are detected in forests, at spas and near waterfalls. It was reported that these improved the subjective comfort. To investigate the physiological effects of negative air ions on human, we analyzed the current perceptive thresholds and autonomic nerve functions using fine water droplets by electrostatic atomization. Methods In the artificial climate room (25 degrees centigrade, 50 % humidity), ten healthy male students were double-blindly exposed for 40 minutes to negatively charged fine water droplets in the air by electrostatic atomization. We examined current perceptive threshold (CPT, Neurometer NS3000, Neurotoron Co.) on their right forearm skins, low frequency (LF as sympathetic nerve function) and high frequency (HF as parasympathetic nerve function) components of heart rates by the accelerated sphygmograph (SA-3000P, Tokyo Iken Co.) on their left fingers and skin temperature on both index fingers. At the 15minutes after the exposure of negative air ions, both their hands were immersed for 3 minutes in 15 degrees centigrade water (cold water immersion test). After 40 minutes, we sampled the blood to analyze hormonology and immunology. We statistically analyzed paired t-test (p<0.05) between the exposure of negative air ions and control. Results There were no difference in CPT of A beta fiber (touch sensation) and A delta fiber (acute pain sensation), but the CPT of the C fiber (chronic pain sensation) in negative air ions was significantly higher than that in control. The finger temperature in negative air ions recovered more quickly after the cold water immersion test than control. HF component in nanoe was higher and LF component in negative air ions was lower than control. CD16+CD56+Natural killer (NK) cells in negative air ions were significantly lower than those in control. Conclusion The fine water droplets in the air significantly reduced chronic pain sensation, reduced sympathetic nerve function and significantly reduce the immunological stress. The fine water droplets in the air by electrostatic atomization may improve the pain and autonomic nerve function as negative air ions in good environment like forests. P7 Development of natural calcium- and phosphate-donating molecules and a new iontophoretic apparatus for the topical treatment of osteoporosis Gomez Izabella1, Pap Lajos2, Pap jr. Lajos3, Szabo Andrea4, Szekanecz Zoltan5 [Hungary] 1 - Department of Rheumatology, University of Debrecen Medical Center, Institute of Medicine, Debrecen 2 - Department of Inorganic and Analytical Chemistry, University of Debrecen 3 - Digitaltechnik, Technische Lehranstalt, Vienna, Austria 4 - Department of Experimental Surgery, University of Szeged 5 - Department of Rheumatology, University of Debrecen Medical Center, Institute of Medicine, Debrecen Gomez Izabella Nagyerdei str 98 H4032 Debrecen (HU) +36 202280928 izagom@yahoo.com Background Apart from systemic treatment of osteoporosis, topical treatment may be useful to treat local bone defects, fractures and other bone disorders. Objectives We have developed a novel iontoforesis device and a topical treatment protocol. Two natural-based, chemically modified nanomolecules have been developed. In addition, a novel 3-electrode electrophoretic device has been constructed. Methods This device ’knocks out’ Ca2+ and PO43- ions from the nanomolecules with its impulse-like positive and negative charges transmitted through its electrodes placed on the skin. Subsequently, these ’knocked out’ ions are channelled into the treated bones with the help of a reference electrode. In our preliminary in vitro studies, we used porcine tissues to test their calcium and phosphate content after iontophoresis. In addition, we performed preliminary in vivo experiments in ovariectomized rats. Results Our major results are the development of two nanomolecules that are able to donate calcium and phosphorous into the bone. Also, a new 3 electrode iontophoresis apparatus has been developed. In vitro studies revealed that both calcium and phosphate ions became incorporated into the porcine bone. When only iontophoresis was applied without using nanomolecules, the calcium content of the muscle tissue on the anode side decreased after iontophoresis (235.7±66.7 μg/g) compared to controls (278.2±33.2 μg/g) (p<0.05). When nanomolecules were also applied in addition to iontophoresis, calcium content of the skin and bone significantly increased in treated tissues (793.0±108.6 μg/g and 207628±16198 μg/g, respectively) in comparison to controls (319.7±38.9 μg/g and 124560±15551 μg/g, respectively) (p<0.05). Similar results were found regarding the phosphate content. In the rat in vivo studies, quantitative ultrasound indicated significant bone loss in the tibia in ovariectomized rats compared to sham-operated animals. Five courses of iontophoresis resulted in increased bone density as indicated by significantly higher AD-SoS values in ovariectomized rats in comparison to untreated rats (p<0.05). Conclusion A three-electrode new iontophoretic apparatus, as well as calcium- and phosphate-donating molecules have been developed. Preliminary in vitro experiments using pig tissues suggest that calcium and phosphate ions indeed penetrate into the bone during iontophoresis. In vivo studies in rats suggest that iontophoresis may increase local bone density. P8 Circadian rhythms of corticosteroids in the rat San Jose Arango Carmen [Spain] Dept. of Pharmacology, Pediatrics and Radiology Area of Physical Medicine and Rehabilitation Faculty of Medicine, University of Seville San Jose Arango Carmen Avda. Sanchez Pizjuan, 4 41009 Seville (ES) medhid@us.es Biological rhythms are a natural phenomenon that extens to all levels of functional oganization and development of the living systems. The biological rhythms depend of specific structures which are integrated by the central nervous system. They give autonomy to the organism to cope with the information that comes from the outside world by means of the senses, so that the organism keeps its internal balance. Each organism has to be syncronized with the changing circunstances of the environment. We all know that many years ago Cannon showed the answer to the stress due to the noradrenaline, the hormone that the organism release for the “fight” or the “run away” and that acts over the functions of hearth, lungs and metabolism, which are modified for one or another stress situation. Later, Seyle defines his “Adaptation General Syndrom” with the release of ACTH and corticosteroides. Objetives To determinate the circadian rhythm of corticosteroids in our laboratory rats under experimental conditions like regular cycle of light and darkness, constant temperature and minimal stress condition. We want to determinate the basal levels of corticosterone every four hours in a period of 24 hours. This is the previous experimental work to demonstrate the influence of natural antistressors like negative air-ions, aquatic exercise and balneotherapy. Material and method We used Sprague dawley rats subjected to a regular light-darkness rhythm 14:10 and constant temperature. The corticosterone determination of blood samples was the fluorimetric methos of Ramaley with some modifications introduced by us. Results and conclusion The peak of corticosterone was maximum at 6 p.m. and minimum at 10 p.m. There is a significant rhythmicity of corticosterone levels during the 24 hours period, measured on each 4 hours samples. As the rat is a rodent of nocturnal life, the maximal peak of plasmatic concentration of corticosterone is around 2 hours before the darkness period, so that the peak at 6 p.m. coincides with the restoration of the motor activity and the awakening. We can conclude that the highest levels of seric corticorsterone in the rat are due to the period of transit from light to darkness, meanwhile the lowest values are due to the period of change from darkness to light. P9 Evaluation of adipokines level at patients with osteoarthritis treated with mud Ionescu Elena Valentina2, Suta Maria1, Surdu Olga1,2, Marin Viorica2, Demirgian Sibel2, Lilios Gabriela1, Menendez Camporedondo Florana3 [Romania] 1 - Ovidius University Constanta 2 - Balneal and Rehabilitation Sanatorium Techirghiol 3 - Universita Di Roma La Sapienta Elena Valentina Ionescu B-dul Aurelo Vlaicu nr.3 bl.D2, apt. 31 900055 Constanta (RO) +40 241481717 / +40 752129142 ionilein76@yahoo.com Background The scientific interest in the biology of white adipose tissue (WAT) has increased since the discovery of leptin in 1994. The description of the product of the gene obese (ob) demonstrated the role of adipose tissue in the physiopathology of obesity-related diseases, and helped to increase the identification of numerous other adipokines, many of a pro-inflammatory nature. It has become increasingly evident that WAT-derived adipokines can be considered as a hub between obesity-related exogenous factors, such as nutrition and lifestyle, and the molecular events that lead to metabolic syndrome, inflammatory and/or autoimmune conditions, and rheumatic diseases. WAT has since been found to produce more than 50 cytokines and other molecules (leptin, adiponectin, rezistin, visfatin, etc) the study of their role is yet in early stages. The mud has remained mysterious, unknown and full of surprise even today, although was used in therapeutic purposes since ancient time. Thermal mud is a therapeutic agent widely used in the treatment of arthritic processes. Osteoarthritis is an important rheumatic condition characterized by the progressive destruction of cartilage. Several adipokine like leptin and adiponektin are reported to be responsable for inflammation and cartilage degradation in osteoartritis associate with obesity or cardiovascular pathology. Objectives 1. To evaluate serum level of leptin and adiponektin after 10 procedures of mud applications. 2. To correlate the serum level of proinflammatory factors, metabolic markers with the serum level of adipokins. Material • Sapropelic mud from the deposit of the bottom of Techirghiol lake, salted water of the lake and all devices needed for specific hydro-thermotherapy, electrotherapy, kinetotherapy and massage • Blood samples • Specific reactors for the determination of human leptin and adiponectin using Eliza technique Methods We performed a study on 38 patients with knee osteoarthritis. 32 patients for the study batch and 6 patients for the witness batch treated in March 2010 in B.R.S. from Techirghiol The study batch received 10 sessions of mud bath. The witness batch do not received anykind of therapeutic bath. The blood samples were taken for all patient before they started balneotherapy and in the end of the cure. Including criterias Patients with the age between 40 and 70 years, diagnotized with knee osteoarthritis. Exclusion criterias Severe CRD and kidney failure, cancers, other organs failure, presence of inflamatory diseases, presence of liquid reversal of the knee, treatment with steoridian and non steroidian anti-inflamatory 30 days before. Statistical indexes were calculated for each parameter and the significant values were compared. Results Leptina 1 Leptina 10 Lep10-Lep1 Adiponectina 1 Adiponectina 10 Ad10-Ad1 Media 30,10 24,9 -5,12 18,00 15,35 -2,65 Minim 0,90 2,90 -52,80 4,80 4,70 -15,00 Maxim 87,50 75,90 11,50 41,80 30,50 10,60 Dev. Stand 23,10 19,03 11,28 8,71 6,15 5,57 Varianta 533,67 362,28 127,14 75,83 37,79 31,07 P 0,72 0,75 0,88 0,84 0,75 0,78 p 0,28 0,25 0,13 0,16 0,25 0,22 Conclusion The data suggest that mud bath therapy influences adipokine related to osteoarthrosis pathomechanism, and encourage further investigations to evaluate mud bath therapy. Keywords : leptin, adiponectin, knee osteoarthritis References 1. Francisca Lago, MD, Carlos Dieguez, MD, Juan G?-Reino, MD, Oreste Gualillo, MD. Adipokines As Emerging Mediators of Immune Response and Inflammation. Nat Clin Pract Rheumatol CME. 2007;3(12):716-724. © 2007 2. Surdu Olga. Evaluarea factorului chimic de actiune al namolului sapropelic de Techirghiol-Gramar 2006 3. DeLisa Joel A, Gans Bruce M, Walsh Nicolas E, Bockenek William L, Frontera Walter R, Geiringer Steve R, Gerber Lynn H, Pease William S, Robinson Lawrence R, Smith Jay, Stitik Todd P, Zafonte Ross O. Physical Medicine & Rehabilitation : Principles and Practice, 4th Edition, Copyright ©2005 Lippincott Williams & Wilkins, VOL I, part IV, chapter 32, p 767-769, (2005) 4. Hunter DJ, March L, Sambrook PN. Knee osteoarthritis : the influence of environmental factors. Clin Exp Rheumatol 2002,20:93-100. P10 The osmotic effects role in the mechanisms of mineral waters action 
Gozhenko AI, Gozhenko OA [Ukraine] State Enterprise Ukrainian scientific-research institute of transport medicine Gozhenko A State Enterprise Ukrainian scientific-research institute of transport medicine 92, Kanatnaya str., Odesa, 65039, Ukraine + 38 (094) 9511593 / F + 38 (048) 7281452 ocean-lad@yandex.ru Despite more than 200-year history of mineral water balneotherapy, to date their clinical use is based mainly on empirical experience, which is supported by laboratory-functional confirmation of clinical efficacy. A new physiological paradigm of balneotherapy with mineral water is proposed. Mineral water has a therapeutic effect via the regulation of water-salt homeostasis. It should provide two levels of mineral water influence : a systemic and cellular-tissue (organ). 
When the influence on the systemic level, one of the main parameters is osmolality of mineral water. Osmotic effects of mineral waters affect the transmembrane water transport and osmoregulation system of the organism. In this regard, one of the major additions to the existing classification of mineral waters is the replacement the criteria of mineralization on the osmolality, which will ensure the transition to the physiologically based criteria of the water characteristics. Mineral water should be divided into hypo-osmolality and low-osmolality, iso-osmolality and hyper-osmolality. Physiologically important components of mineral water include : ionic and anionic composition of the macro-elements, acid-base characteristics, bioactive microelements, organic substances. P11 Chronic hyperventilation : the missing piece [of diagnosis]. An exploration of the relationship between chronic hyperventilation and chronic degenerative diseases Czeranko Sussanna [USA] Dr Sussanna Czeranko c/o NCNM 49 SW Porter St Portland, Oregon 97201 [W]: +1 [503] 552-1708 [H]: +1 [503] 236-3140 sczeranko@ncnm.edu Imagine the surprise and elation that your patients will feel when their symptoms can be significantly alleviated and cured with simple breathing exercises rather than expensive pills. No more fatigue, snoring, asthma, sleep apnea, seasonal allergies or even panic attacks. The toll that stress plays in our lives accumulates into a myriad of diseases and symptoms that can be alleviated by healthy breathing. Every day in America 40,000 people miss school or work, 30,000 people have an asthma attack, 5,000 people visit the emergency room, 1,000 people are admitted to the hospital and 15 people die due to asthma. One in 15 Americans suffer from sleep apnea. Poor breathing habits compromise many aspects of our health. Dr. Konstantin Buteyko (1923-2003), a Russian medical researcher turned what we assume healthy breathing to be, upside down and inside out. Find out how. How could breathing, that is so vital and essential for our lives, be often passed over as an important focus for our treatment plans with our patients ? Our lives spin completely out of control as the stresses that we face multiply. Given that stress is probably the number one reason why patients make appointments with doctors, having a powerful, natural tool for our repertoire is highly desirable. Buteyko breathing is that tool. The controversial view that deep breathing was a significant cause of many of the “diseases of civilization” was systematically proven by a Russian doctor, Dr. Konstantin Buteyko (1923-2003). Dr Buteyko, was a true pioneer. He formulated breathing exercises that restore and retrain our breathing to a healthy pattern. His observations on respiratory functions parallel standard mainstream medicine and he used the same medical paradigms to substantiate his methods and clinical outcomes. Across a fifty-year span of clinical practice, the record shows that Dr. Buteyko cured over a 100 diseases, such as infertility, endometriosis, hypertension, headaches, asthma and other respiratory diseases, anxiety and many others. He turned upside down our preconceived ideas of what healthy breathing is. This remarkable medical scientist is widely known in Europe and Russia and was ahead of his time. We will review the theory, the science and the studies so that you can change the lives of your patients. Learning objectives Gain an understanding from the Buteyko point of view of what constitutes healthy breathing. Re-discover the science of healthy respiration. Learn how stress impacts our breathing and ultimately our health. Learn simple breathing exercises that can be immediately used in a naturopathic practice to help patients respond to stress and illnesses. Clinical cases presented. P12 Morbi-mortality of 600 ambulatory patients with intermittent claudication. Twenty year prospective follow-up, ROYAT Survey 1981-2006 Fabry Régine1, Monnet Pascal2, Duru Gérard3, Pittler Max H4, Baguet Jean-Claude2 [France / Utd Kingdom] 1 - University Clermont 1, Department of therapeutic 2 - Cardiovascular Research Institute, Royat 3 - Health economy, CNRS UMR 5823, Lyon 4 - Department of complementary medicine, University of Exeter, England Fabry Régine Service de Thérapeutique et Hydrologie Climatologie Médicales 63001 Clermont-Ferrand cedex 01 (FR) Regine.FABRY@u-clermont1.fr The aim of this prospective study, initiated in 1981, was to follow disease course in a homogeneous nationwide patient population suffering from Fontaine stage II and treated annually at a French spa that specializes in topical treatment of arteriosclerosis by natural carbon dioxide. The patients from all regions of France were recruited from 1981 to 1986 (568 men and 32 women with a mean age of 56±9 years, onset of the disease 5±4 years before inclusion) and had moderate claudication (walking distance : 365±231 m ; systolic pressure index at rest : 0.72±0.16) but no other local symptoms of arteriosclerosis and were non diabetic. The cohort underwent annual follow-up (collection of medical data, treadmill walking test and doppler ultrasonography). Death events were recorded at each review (after 5, 10, 15 and 20 years) and expressed as the cumulative number of patients. Only four patients were lost to follow-up : one at 5 years, two at 10 years and one at 20 years. Deaths from tumours were comparable in number at 5 years to those due to cardiovascular disease. The main causes of death after 10 years in decreasing order of importance were : cancers (42.7 %), of which 54 % were attributable to smoking (pulmonary, ENT and vesical tumours) ; cardiovascular disease (37.6 %), in 61 % of cases myocardial infarctions ; and extra-cardial complications of vascular surgery (3.2 %). The total mortality after 20 years was 53.8 % (321/596) and the annual incidence was 2.7 % as against 1 % in the general population (Insee, National Institute of Statistics and Economic Studies). After 20 years of follow-up, deaths from cardiovascular disease accounted for 34 % of total mortality, with 41 % of deaths due to myocardial infarction. At the same time deaths from tumors had risen to a level of 41.4 %. There was a statistically significant decrease over the follow-up in the number of myocardial infarctions but a rise in deaths from smoking-related tumors. There was no change in deaths from cerebro-vascular accidents at 10 and 15 years (5.8 %) but an increase at 20 years (11.2 %). Other causes accounted for 16 % of total deaths. The medical management of stage II must be global and ally vasomotor rehabilitation by CO2 therapy with regular daily walking, the elimination of tobacco consumption (at 15 years, 75 % of our patients no longer smoked). P13 Prevalence of low back pain in Kosovo industrial workers Murtezani Ardiana1, Bytyci Cen2, Orovcanec Nikola3, Hundozi Hajrie1, Kamberi Lumnije1 [Republic of Kosovo]
 1 - Physical Medicine and Rehabilitation Clinic, University Clinical Center of Kosovo. 2 - Orthopedic and Traumatic Clinic, University Clinical Center of Kosovo 3 - Department of Epidemiology and Biostatistics, Faculty of Medicine, Skopje, Macedonia Murtezani Ardiana Rr. e Spitalit pn. 10000 Prishtina, Republic of Kosovo (AL) +381 38 517 961 / +377 44 220 475 ardianaa@yahoo.com Background Low back pain (LBP) is one of the most common causes of muskulosceletal disorders related to work status and condition. LBP remains the predominant occupational health problem among industrialized countries and in low income countries. Both work characteristics and individual factors have been identified as risk factors. However, most research activity has focused on physical solutions including manipulation, exercise training and activity promotion. The objective of the present study was to determine the interrelation between individual factors and prevalence of low back complaints and to investigate the associations between physical activity and severity of LBP. Methods This is a cross-sectional study that was conducted among 430 workers of an industrial company, Energetic Corporation of Kosovo, over the previous 6 months. Interwiev, questionnaire survey, medical examination, radiographic evaluation and ergonomic survey were the methods to collect data. We created two groups according to the answer to question : (1) with low back pain, (2) without low back pain. Group 1 (with LBP) was then divided into three subgroups according to the answer to question (a) LBP without irradiation, called mild cases, (b) LBP with irradiation above the knee, called moderate cases, LBP with the irradiation below the knee, called severe cases. Results The results of the study showed that low back pain occurred in 61,6 % of workers. None of the demographic variables and work-condition variables (working years on the current job) was found to be significant risk factors for induction of LBP among the employees (p>0,05). The prevalence of LBP was significantly associated with physical activity, p=0,03. There is a significant difference between frequent physical activity and severity of LBP, p=0,01. Conclusion Daily life conditions, job-related factors are associated with the occurrence of low back pain. These results suggest that individuals with low back pain should refrain on nonspecific physical activities to reduce pain and improve psychological health. Key words : Cross-sectional, low back pain, risk factors, physical activity References 1. Hurwitz EL, Morgenstern H, Chiao Ch. Effects of Recreational Physical Activity and Back Exercises on Low Back Pain and Phychological Distress. American Journal of Public Health, October 2005, Vol 95, No. 10. 2. Holmberg S, Thelin AG, Stiernstrom EL, Swardsudd K. Low back pain comorbidity among male farmers and rural referents. Ann Agric Environ Med. Sweden, 2005,12:261-268. 3. Mazloum A, Nozad H, Kumashiro M. Occupational low back pain among workers in some small-sized factories in Ardabil, Iran. Industrial Health 2006, 44:135-139. 4. Nieuwenhuyse AV, Fatkhutdinova L, Verbeke G, Pirenne D, Johannik K, Somville PH, Mairiaux Ph, Moens GF, Masschelein R. Risc factors for first ever low back pain among workers in their first employment, Occup. Med. Belgium, 2004; 54:513-519. 5. Turner JA, Franklin G, Keohe DF, Egan K, Wickizer TM, Lymp JF, Sheppard L, Kaufman JD. Prediction of chronic disability in work-related musculoskeletal disorders, BMC Muskuloskeletal Disorders, Washington, 2004,5;14. 6. Nieuwenhuyse AV, Somville PR, Crombez G, Burdorf A, Verbeke G, Johannik K, Van Den Bergh O, Masschelein R, Mairiaux Ph, Moens GF. The role of physical workload and pain related fear in the development of low back pain in young workers, Occup.Environ.Med. Belgium, 2006;63:45-52. 7. Aasa U, Bergkvist MB, Angquist KA, Brulin C.Relation ships between work-related factors and disorders in the neck and low back region among female and male ambulance personnel. J Occup.Health 2005, 47; 481-489. 8. Patel AT, Ogle AA. Diagnosis and Management of Acute Low Back Pain. University of Kansas City, Kansas, 2000;1779-86,1789-90. 9. Cleland JA, Fritz JM, Childs JD, Kulig K. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patient with low back pain who satisfy a clinical prediction rule: study protocol of a randomized clinical trial. BMC Muskuloskeletal Disorders 2006,7:11. 10. Delitto A, Erhard RE, Bowling RW. A Treatment-Based Classification Approach to Low Back Syndrome : Identifying and Staging Patients for Conservative Treatment. Physical Therapy Volume 75, Number 6, June 1995. 11. Busanich BM, Verscheure SD. Does McKenzie Therapy Improve Outcomes for Back Pain ? Journal of Athletic Training 2006;41,1;117-119. 12. Van Dillen LR, Sahrmann ShA, Norton BJ, Caldwell CA, Fleminig DA, McDonnell MK, Woolsey NB. Reliability of Physical Examination Items Used for Classification of Patient With Low Back Pain. Physical Therapy Volume 78. Number 9.Sep.1998. 13. Van Den Hoogen HJM, Koes BW, Deville W, Van Eijk JTHM, Bouter LM. The inter-observer reproducibility of Lasegue’s sign in patient with low back pain in general practice. British Journal of General Practice December 1996,46:727-730. P14 Study of the reasons of infectious abortions in the subjects who approached Kamali Hospital in Iran Massiha Alireza, Majid Khoshkholgh Pahlaviani Mohammad Reza, Sedighi Kasmaie Parisa [Iran] Islamic Azad University of Iran-Lahijan Branch Massiha Alireza Department of microbiology-basic of sciences-shaghayegh street. Islamic Azad University of Iran - Lahijan +98 4414887761 Lahijan (IR) amirmassiha@yahoo.com 
 Research Background and Objective Infectious diseases are one of remarkable problems in women such that 15 % of women’s death rate results from abortion. Almost half of this rate is caused by infection. The subjects in Kamali Hospital in Karaj were studied considering the parameters of age, pregnancy term, abortion history and contamination by infectious factors that the findings can be used in hygienic planning. Method Serological tests of EL ISA and IFA were conducted on serums obtained from 84 subjects’ blood and vaginal secretion was also used for culture in some cases. Results Of 84 samples collected due to Toxoplasmosis, Mycoplasma, Listeria, Brucella and Chlamydia infectious factors from July-Aug., 2006 to Feb.-March, 2007, 17 samples (20 %) were related to Toxoplasma infection, 30 samples (35 %) were related to Mycoplasma infection, 9 samples (11 %) were related to Listeria infection, 8 subjects (9.5 %) were related to Brucella infection and 2 samples (2.3 %) were related to Chlamydia infection and the highest rate of abortion occurred in 20-30 ages and the highest rate of frequent abortions has occurred in 20-30 ages as well. Discussion Considering importance of infectious factors which result in abortions, we concluded that the most incidences are related to infectious factors of Mycoplasma, Toxoplasma and Listeria. Considering zoonotics of Toxoplasma and Listeria factors and this that Karaj is a region where people are engaged in animal husbandry, we may find a relation between abortion and these factors. Mycoplasma is also spread by sexual relations and considering the fact that the age groups who abort are young, thus it is necessary to study infectious factors, age parameters, pregnancy term and frequent abortions in Karaj. Key words : Abortion, Infectious factors, Karaj province P15
 A survey of the prevalence of vaginitis and vaginosis common microbial factors in outpatients and bedridden patients in north of Iran during 2007-2008 Majid Khoshkholgh Pahlaviani Mohammad Reza, Massiha Alireza [Iran] Department of microbiology-basic of sciences- Islamic Azad University of Iran, Lahijan Mohammad Reza Majid Khoshkholgh Pahlaviani shaghayegh street. Islamic Azad University of Iran - Lahijan +98 4414887761 Lahijan (IR) uranium92000@yahoo.com Vaginitis is among the most common conditions for which women seek medical care, with vaginal discharge accounting for 10 million office visits each year. Although vaginitis can have a variety of causes, it most often is associated with infection or atrophic changes. Common infectious forms of vaginitis include bacterial vaginosis, vulvovaginal candidiasis and trichomoniasis. Although these infections generally respond to treatment, misdiagnosis and, rarely, pharmacological resistance may occur. In this study we examined the prevalence and risk factors of vaginitis of 440 inpatient and outpatients women attending a hospital in lahijan-north of Iran during 2003-2004. The traditional diagnosis of vaginitis incorporates patient symptoms, clinical findings observed during vaginal examination, and laboratory analysis of vaginal fluid. The results of this survey obtained from the 440 subjects in the sample show, the most prevalent cases are : Bacterial vaginosis (21.1 %), Candida albicans (19.3 %) and Trichomonas vaginalis (15.2 %). The results also reveal that (61.2 %) of the people who suffering from bacterial vaginosis are above 30 years. Whereas 69.7 % of the people suffering from bacterial vaginosis and 38.8 % of the people infected by trichomonas vaginalis are below 30 years of ages. A further comparison carried out this survey was between the literate and illiterate and also employed and unemployed women. The results indicate that the literate and unemployed women were more susceptible to danger. Moreover, the study also investigated the influential factors which might lead to the emergence of the disease. Keywords : prevalence, vaginitis, Bacterial vaginosis Resorts P16 Burgas bay in Bulgaria - a resort with many healing factors of natural origin. Resort development prospects and worldwide analogues. Kazaryan Tigran [Bulgaria] balneo-spa-wellness center “Grand hôtel Pomorie” Tigran Kazaryan Balneo-spa-wellness center “Grand hôtel Pomorie” 5 Professor Stoyanov Str. 8200 Pomorie Bulgaria Bay of Burgas can truly be considered a resort which offers all currently known healing factors of natural origin for spa treatment. Our planet has many such discernable resort areas. They are mostly located near seas or oceans. A number of them are shown on the slideshow of this report, using the “Google Earth” program. The term “Asclepius Ellipsoid” was introduced for the purpose of describing the Burgas bay resort areas along with many other such locations around the world. This imaginary ellipsoid’s lower hemisphere is positioned underground, encompassing all natural resources of our planet, while its upper hemisphere includes the specific climate properties within these arbitrary boundaries. The main condition for establishing an Asclepius' Ellipsoid is a strictly defined geographical location (of a couple of tens of kilometers), within which there are at least two distinguishable microclimates with therapeutic properties and almost all known hydromineral medicinal resources (therapeutic mud, mineral waters, clay, etc.). And so, the geographical position of the lower, underground hemisphere of the ellipsoid in the Burgas bay area, includes the following hydromineral resources : Deposits of therapeutic mud in the Atanasovsko and Pomorie lakes ; Medicinal lye from the Atanasovsko and Pomorie lakes ; Mineral waters : Rapa water from the Atanasovsko and Pomorie lakes, “Burgas Mineral Baths”, mineral waters from the Balkan Mountains, saline mineral water from the spring on the territory of “Grand Hotel Pomorie” ; Healing clay ; The Black Sea, firth lakes and sand ; Healing salts. The upper hemisphere is comprised of three microclimates : Mountain-Sea climate ; Sea climate ; Lake-sea climate. As you can now see, the Asclepius’ Ellipsoid is characterized by a multitude of spa resources, located within a small area of land. This remarkable feature provides rehabilitation medicine with unlimited possibilities for treatment. Using Asclepius’ Ellipsoid, we can differentiate three possibilities for rehabilitative medicine development on this territory : 1. Rehabilitation medicine The main components for treatment are therapeutic mud and stem cells. Indications Implications resulting from injuries to the brain Genetically predetermined brain diseases (dementia, Alzheimer’s disease, Parkinson's disease, etc.) Implications resulting from brain infections (cerebral palsy, complications from encephalitis, resulting from comatose states, etc.) Spinal cord traumas Fighting against aging (anti-aging) Etc. 2. Recreational medicine The main components for treatment are balneologic treatment resources, spa methods, physiotherapeutic equipment. Indications Diseases of the skeletal system Diseases of the peripheral nervous system Disease of the endocrine system Neuroses (chronic fatigue syndrome, stress, etc.) Excess weight (weight loss) Detoxification (detox) Etc. 3. Wave medicine (bioenergy) The main components for treatment are “pyramid” salt lamps and structured water Indications Heart and pulmonary system diseases (bronchial asthma, pulmonary bronchoectasis, heart failure, etc.) Cardiovascular and respiratory system diseases (bronchial asthma, bronchoectasis, heart failure, etc.) The report describes the methods and approaches for the implementation of some of the above mentioned medical projects. P17 Potential health benefits of two water sources from Bicaz Gorges-Hamas Mountain National Park - Indications for balneology medical treatment Stratulat Sorin Ioan, Dragomir Sever, Pinzaru Maria [Romania] Gr. T. Popa University of Medicine and Pharmacy Iasi CF Clinical Hospital, Rehabilitation, Physical Medicine and Balneoclimatology Department Stratulat Sorin Ioan Universitatea de Medicina si Farmacie Gr.T.Popa, Str. Universitatii nr.16 700115 Iasi (RO) dr_sorin_stratulat@yahoo.com 
 In this study we are presenting the results of water source analysis from a natural protected habitat in the north-eastern part of Romania. Geographically, the aquifer source is in a mountain landscape belonging to the cristalino-mesozoic group of Oriental Carpathians, the median group, Bistrita - Hăghimaş Mountains. In geological terms, the study area belongs to Hăghimaş canvas, which consists of massive limestone deposits from the upper Jurassic and lower Cretaceous. Hydro-geological exploration carried out in the study area revealed that calcareous deposits are a great collector of rain water which is emerging from the slope with variable flow. Thus, we identified a total of 17 oligo-mineral water sources appearing as springs, of which only two were selected. The waters were subjected to physico-chemical and microbiological analysis and for determination of radiation characteristics (nuclides features, global alpha and beta). The results are certifying, by all accepted norms and current european legislation, that it is a drinkable natural water that can be used in external and internal balneology treatment and for the preparation of milk powder for children between 0 and 1 year. P18 Thermal Water and Tourism Development in Minas Gerais (Brazil) and Andalucía (Spain) Carvalho Alvim Frederico [Spain] Brazilian student of the European Postgraduate Program 
Carvalho Alvim Frederico Calle Alfonso XII, 16 41002 Sevilla (ES) +34 628 357 639 uenf.fred@gmail.com 
This abstract presents a general introduction to a PhD concerning thermal waters, their benefits and their environmental and cultural impact on the Brazilian city of Pocos de Caldas and the Spanish city of Alhama de Granada. This research is currently being developed by the Brazilian student Frederico Alvim Carvalho within the European Postgraduate Program entitled “Social Science applied to Environment Issues” (Universidad Pablo de Olavide, Sevilla, Spain). This study links the social and environmental issues in two regions (Brazil and Spain) that are currently undergoing tourist development due to the wealth of thermal and mineral waters. This research employs qualitative methodology in a close examination of two cases:  tourism development in Pocos de Caldas and the evolution of Spain’s plan for tourism and thermal water in Andalucía (Spain). This study confirms the benefits and environmental and social impact of a process incorporating rapid tourism development in areas with thermal waters.
The main objective of this study is to evaluate the direct and indirect impacts (and benefits) in the cities with thermal water in Brazil and Spain. This study reveals social-cultural and environmental impacts (and economics benefits) resulted from a rapid tourism development.
Finally, we expect with this research have more knowledge and information that may contribute to a sustainable local management in territories with thermal waters. P19 Spanish national observatory of thermal water and rural development Javier Ballbé Mallol [Spain] Asociación termalismo de Andalucía Ballbé Mallol Javier Calle del Hospital, 1 18120 Alhama de Granada (ES) +34 661 50 90 94 direccion@termalismodeandalucia.com Objectives Analysis of the Spanish thermal sector and its contribution to rural development. Thermal water resources inventory and spa heritage of Spain. Evaluation and promotion of public policies to support the thermal water sector. Technical assistance to local development projects related to thermal water. P20 Socio-demographical characteristics of patients attending the Copahue hot springs (Neuquen-Argentine). Preliminary study Vela Lorena1,3, Jorquera L2, Bonino P1, Monasterio A1,3, Maraver Francisco3,4 [Argentina, Spain] 1 - Provincial Thermal Entity of Neuquen, Argentina 2 - School of Tourism - National University of Copahue, Argentina 3 - Chair of Medical Hydrology – School of Medicine – UCM, Madrid, Spain 4 - Physical Medicine and Rehabilitation. Medical Hydrology Department, School of Medicine – UCM, Madrid, Spain Vela Lorena Chair of Medical Hydrology – School of Medicine, UCM 28040 Madrid (ES) hidromed@med.ucm.es Introduction The Copahue Spa is located at 2010 m.a.s.l., over Volcano Copahue, Los Andes mountain Neuquen Argentinian Patagonia. It opens from December 1st to April 30th. Approximately 7000 patients attend the Spa. There are records of sanitary activity that date from 1890, although the Spa has had an organised medical service since 1950. In Copahue Spa works ten doctors, although the Spa has had an organised dermatology service since 1990. Besides, It has a rehabilitation service with 8 physiotherapist and 5 teachers of physical education. There works 200 thermal assistants and they do 2500 treatments per day. The main pathologies treated are respiratory, dermatologic and those related to the musculoskeletal system. It is worth noting the use of volcanic mud naturally matured in the “Chancho lagoon” : dry residue 2067.2 mg/L, sulphates (SO4=1437.74 mg/L), calcium (Ca++=76.96 mg/L), total iron (Fe=31.2 mg/L). Objective To study the socio-demographical characteristics of the Spa patients and repercussions of economic type Material and method A survey containing socio-demographic related questions, designed by experts in thermal management, has been carried out to 205 patients randomly selected. Those who polled were students of medicine of the National University of Comahue. To analyze the information there has used the statistical program DYANE 95 and criticize discussion for the authors of the work Results-Discussion As regards the gender, seventy-one per cent of the surveyed are female and twenty-seven per cent are male. The average age is 55 years. Sixty-four per cent had previously attended the Spa, having been there an average of 8 seasons for approximately 7 days. Eighty per cent spends approximately 50 dollars per day in stay, only ten per cent spends over 100 dollars per day. Fifty per cent have Medical private assurance, from these to twenty per cent covers five per cent of the thermal treatment, to seven per cent covers hundred per cent and to eighteen per cent covers eighty per cent of the treatment. Seventy-five per cent does not receive any kind of help from medical insurance to carry out treatment. Sixty-three per cent attends the Spa with a therapeutic aim ; twenty-one per cent does it in a preventive way and fifteen per cent with a recreative aim. Of this preliminary study there is deduced that most of our visitors are senior citizens, attend the Spa with a therapeutic aim and satisfy their needs, thus becoming faithful to this destination. The average cost of the therapeutic thermal more the cost of demurrage in 7 days for person is 1300 dollars, being the basic salary established by the Argentine nation of 1000 dollars for what we can conclude that our visitors belong to a middle/high socioeconomic status. Keywords : Copahue Spa, Spa therapy, mudtherapy, climatotherapy, economic issues, Argentine. Bibliography 1. Alvarez G. Contribución al estudio de las termas de Copahue (Neuquen, en sus aplicaciones dermatológias. Bol Asoc Med Argent 1938;4:220. 2. De Monte H. Caviahue – Copahue. Mito y Realidad. Sintesis de su historia. Neuquen Ediciones Verdes, 2004. 3. Monaterio AM. Copahue, lugar de Baño Rosario : T.G. iefe SRL, 2007 4. Sussini M, Herrero E, Brandam RA, Isnardi H, Galmarini AG, Castillo M, Pastore F. Aguas Minerales de la Republica Argentina – XIII Territorio del Neuquen. Buenos Aires : Ministerio del Interior – Comisión nacional de Climatologia y Aguas. 1938. 5. Ubogui J, Stengel FM, Kien MC, Sevinsky L, Rodriguez Lupo L. Thermalism in Argentina. Alternative or complementary dermatologic therapy. Arch Dermatol 1998;134,11:1411-1412. 6. Zingoni E. Crenoterapia respiratoria Termas de Copahue. Neuquen: Ediciones patagñas. 2009. P21 Thalassotherapy in Brazil Israel Vera Lúcia1, Goncalves Anelise Macalossi2, Moriggi Fernanda de Amo2, Geraldo Adriana Cristina Andrade2 [Brazil] 1 – UFPR Litoral, Professor 2 – UFPR Litoral, students of physical therapy Israel Vera Lúcia Rua Jaguariaiva, 512 83260000 Matinhos Paraná (BR) +55 41 3511 8301 / +55 41 9962 2163 veral.israel@gmail.com In the Brazilian reality of a tropical climate, talassotherapy has spread very little. Its use began in Rio de Janeiro in 1922. In the south of Brazil there are now health spas that use this technique in bathtubs and pools for the purpose of anti-stress treatment and relaxation. Talassotherapy is used in the treatment of arthritis, osteoporosis, rheumatism, fibromyalgia, skin conditions, as well as to improve the quality of life. With healing properties, it is efficient in the intensification of human metabolism, acting as an anti-inflammatory, bactericide, laxative and detoxifying agent, aside from the behavioral and emotional effects obtained from this therapy, which are a result of the direct contact with nature. Physical activities in talassotherapy may benefit from the healing properties of seawater and the marine atmosphere, thus providing the re-balancing of the extracellular environment, the elimination of toxins, skin re-mineralization and hydration through the use of seaweed, destruction of fat tissue and intensification of skin permeability. P22 The implementation of the quality system LIAMNT - I.N.R.M.F.B. in the conformity with the standards taken from EU Directives Nica Sarah Adriana1, Cosmoiu Madalina1, Murgu Andreia1, Mitoiu Brindusa Ilinca2, Mologhianu Gilda1 [Romania] 1 - National Institute of Rehabilitation, Physical Medicine and Balneoclimatology 2 - University of Medicine and Pharmacy “Carol Davila” Nica Sarah Adriana Bdul Ion Mihalache no.11A, sector 1 011171 Bucharest (RO) +40 213186459 / +40 722567936 sarahnica@gmail.com The accreditation became a necessity for the LIAMNT (The Tests Lab for the Sparkling Waters and Therapeutic Muds) within the National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, and in the meantime an obligation in order to be able to prove the warranty of the quality and the exactness of the returned tests, as well as the national policy inquiries. The new LIAMNT concern is the implementation of the quality system in the conformity with the referential SR ISO/CEI 17025/2005. The general inquiries for the competence of the tests and standardizing laboratories are based on the experience stored in up to 50 years at INRMFB regarding the proper evaluation of the natural therapeutic factors. The accreditation was performed in the conformity with the referential SR EN ISO/CEI 17025:2005, taking into account the existing legislation in the field of the health national system which is stamped to all who are involved to improve and maintain the health status of the population including the finding out, following up and convert into capital the natural therapeutic factors. The major strategic objective of LIAMNT has been in the last period of time the implementation of the quality standards taken from EU Directives in order to face the key conditions of the community aquis and right application of the community exigencies regarding the Unique Market of EU, defined as a zone without internal borders, where there is: free circulation of the products, of the persons, of the services and of the capital having on the base the free market economy. The request as foundation of EU Directives is representing the assurance of the free circulation of the services, having as the basic component the accreditation. The implementation of these policies was shown on The enforcement of standardization and quality infra-structures - national program - INFRAS - which has as main purpose the development of the activities from the frame of the assessment of the conformity and standardization accordingly to those of the European Community, which promote the free circulation and international recognizing of the services. Key words : accreditation, implementation, progress, sparkling waters, therapeutic muds P23 The balneoclimatic conditions in Bulgaria, a foundation for successful health tourism Angelova Tatyana, Kaneva Tsvetelina, Stoycheva Maria [Bulgaria] National Hospital for Physical Therapy and Rehabilitation, Sofia Angelova Tatyana blv.Ovcha kupel 2 v 1618 Sofia (BG) tan_angelova@yahoo.com Bulgaria is country gifted with great natural resources of mineral waters, mud depots and healthy climate –factors necessary for developing the health tourism. At the territory of the country there are about 140 fields of mineral waters with capacity over 5000 l/sec. The physic-chemical composition highly varies : temperature from cold – 12°C to hot 103°C ; mineralization from low mineralized – 120 mg/L to 3400 mg/L. Gases as radon, hydrogen sulphide etc are frequently found in the waters. Along the Black sea coast there are five mud lakes, inside the country there are three turf and spring mud depots in exploitation mode. Bulgarian balneal resorts are located in eco-friendly territories and natural parks, usually at the foot of the mountains Rodopi, Pirin and Rila, the Balkans. The air in them is pure, the climate is moderately continental, mild. The mineral waters and peloids were worshiped by our ancestors since the Antiquity. There are many archeological ruins testifying the development of the balneology in this latitude. Nowadays at the place of the ancient Thracian and Roman therms are built modern balneal stations for prevention, rehabilitation and treatment of many social important diseases. The effect of the natural balneo-climatic factors is proved clinically and experimentally during the years. The income from balneology and balneal treatment is increasing in the last five years and the beneficial tendency of the sector is expected to remain for the following years. P24 Hydrotherapy in Brazil : a historical overview Gluszewicz Izabel Sampaio¹, Souza Franciele Cristina Ferreira¹, Yamaguchi Bruna¹, Israel Vera Lúcia² [Brazil] 1 - Student of Physical Therapy at UFPR – Setor Litoral 2 - Professor of the Physical Therapy Department at UFPR – Setor Litoral Israel Vera Lúcia Rua Jaguariaiva, 512 83260000 Matinhos Paraná (BR) +55 41 3511 8301 / +55 41 9962 2163 veral.israel@gmail.com The water environment brings benefits to patients in all age groups and in different health conditions. In the literature one can find evidence of positive effects on posture, movement, muscle tone, pain, static and dynamic balance, among other things, due to the ruling principles of hydrodynamics. However, only recently has it become the object of more in-depth scientific studies. Physical Therapy in Brazil encompasses hydrotherapy as a privative condition and had its early days around 1922 in Rio de Janeiro, with healthcare characteristics and a rehabilitating and healing purpose. Nowadays hydrotherapy contemplates talassotherapy, thermalism and therapeutic pool, aside from showers and baths, with full attention on human health as a promoter of healthcare, prevention and kinetic-functional recovery in Physical Therapy. In his/her practice the physical therapist utilizes a specific procedure for assessment and intervention, developing programs with water exercises or making use of traditional methods such as : Halliwick, Bad Ragaz, Watsu, Ai Chi. Aquatic Physical Therapy has been growingly utilized in Higher Education undergraduate courses in the field, with a rate of 62 % hydrotherapy in their curriculum. Throughout the 20th century there has been progress in the therapeutic use of Water Physical Therapy, nevertheless there ought to be more encouragement to its practical and scientific application. Keywords : Aquatic Physical Therapy, Hydrotherapy, History P25 Balneology potential of Transkarpathian resorts : The modern conception of rehabilitation treatment of Transcarpathian resorts was introduced Dobra Petro, Chopey Ivan, Dobra Larysa [Ukraine] Uzhgorod State University, Uzhgorod, Ukraine Dobra Larysa Peremohy str 175-46 88015 Uzhgorod (UA) +380312654558 / +380507306269 ladobra@ukr.net Ukraine has one of the most magnificent spa and recreation resources in Europe. The climate and mineral water of Carpathian region are the most valuable resources among them. Who'd ever been to Transcarpathia, he would forever remember the magical nature of this country. Though the Ukrainian Carpathians belong to the forest Atlantic-continental climate zone, they belong to the mountainous region having its special features. The variety and successful combination of healing natural resources give the right to name Carpathian mountains the spa paradise and determine their different recreation profiles. But Transcarpathia is widely known not only because of its splendid natural beauty and mild climate. Nowadays there are more than 300 mineral water sources, which can be used with healing aim. The geological peculiarities of Carpathian mountains had determined complex and different chemical compound of mineral water, which defined the wide range of its healing usage. The main world resources of hydrocarbonate natrium and hydrocarbonate chloride, calcium, calcium-natrium, calcium-magnesium-natrium, nitrate-metanum and other types of mineral water are concentrated in Transcarpathia. Such mineral water, as “Svalyavska”, “Luzhanska”, “Shayanska”, “Sojmy”, “Kelechynska”, “Polyana-Kupil”, “Polyana-Kvasova” e.c. are well known all over the world due to their extraordinary healing qualities. There is great potential in further research of iron-arsenic, sulphide and iodide-bromide mineral water, of climate and other natural factors. Today this kind of mineral water is used in the form of balneotherapy. Spa healing and recreation service are the most perspective, priority and economically interesting branches of business in Transcarpathia. The most important part of spa healing is rehabilitation. It is called to maximally rebuilt patients’ health using the possibilities of surgery, therapy, physiotherapy and other treatment. In highly developed countries, rehabilitation is one of the most important parts of healthcare system, because it helps patients to maintain self-care, work ability and social rehabilitation. The main rehabilitation profiles in Transcarpathia are cardiology rehabilitation (in “Karpaty” resort), haematology rehabilitation (in “Verkhovyna” resort), after abdominal operative gastroenterology rehabilitation (in “Polyana” resort), endocrinology rehabilitation (in “Kvitka Polonyny” resort), spa healing of pregnancy diseases (in “Karpaty” resort). In the whole, Transcarpathia itself has the powerful potential for further development of medical rehabilitation in spa conditions for persons with stroke consequences (in “Karpaty” resort), persons in posttraumatic status and with consequences of professional diseases of joint-muscular system (in “Synyak” resort). There is great possibility to develop endocrinology rehabilitation in children-teenagers rehabilitation (in “Sonyachne Zakarpattya” and “Polyana” resorts). It is possible to create post-stress rehabilitation (after natural and anthropological catastrophes) recreation zones (in “Karpaty”, “Polyana”, “Shayan”, “Verkhovyna” resorts). Transcarpathia is the region with unique natural resources, which are successfully used with healing aim. That’s why it is extraordinary actual to research, preserve and use them rational in the future. It is important to share and generalize experience for the further improvement of rehabilitation service. It helps to achieve important goals like recovery of national health and correction of demographic situation. DAY 2 POSTER SESSION 4.30 pm – 6 pm Medical benefit P26 Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia Shuji Matsumoto [Japan] Matsumoto Shuji 3930-7 Takachiho, Makizono-cho 8996603 Kirishima City (JP) +81-995-644045 / +81-995-782538 shushu@m.kufm.kagoshima-u.ac.jp Fibromyalgia syndrome (FMS) is a chronic disorder that is characterized by widespread pain with localized tenderness. The purpose of this study is to investigated whether thermal therapy combining sauna therapy and underwater exercise improved pain, symptoms, and quality of life (QOL) in FMS patients. The study design is a prospective observational and interventional trial in three rehabilitation hospitals in Japan. Twenty-four female FMS patients (mean age, 45.0±12.2 years ; age range, 24–62 years), who fulfilled the American College of Rheumatology (ACR) criteria, have completed the 6-month study. A 12-week thermal therapy program comprising sauna therapy once daily for 3 days/week and underwater exercise once daily for 2 days/week was provided. As a main outcome measure, pain, symptoms, and QOL were assessed using a pain visual analogue scale (VAS), a fibromyalgia impact questionnaire (FIQ), and a short form 36-item questionnaire (SF-36), respectively. All of the patients reported significant reductions in pain and symptoms of 31–77 % after the 12-week thermal therapy program, which remained relatively stable (28–68 %) during the 6-month follow-up period (that is, the thermal therapy program improved both the short-term and the long-term VAS and FIQ scores). Improvements were also observed in the SF-36 score. This demonstrated that the FMS patients benefited from the thermal therapy in terms of improvements in both clinical parameters and QOL. No adverse side effects were observed. In conclusion, thermal therapy combining sauna therapy and underwater exercise improved the QOL as well as the pain and symptoms of FMS patients. P27 Beneficial effects of footbaths in controlling spasticity after stroke Shuji Matsumoto, Megumi Shimodozono, Seiji Etoh, Yurika Shimozono, Nobuyuki Tanaka, Kazumi Kawahira [Japan] Matsumoto Shuji 3930-7 Takachiho, Makizono-cho 8996603 Kirishima City (JP) +81-995-644045 / +81-995-782538 shushu@m.kufm.kagoshima-u.ac.jp The beneficial effects of footbath treatment for spasticity were studied in 14 post-stroke patients and 14 healthy subjects by recording F-waves. Increases in F-wave amplitude and F/M ratio were observed in post-stroke patients on the affected side before footbath usage. Spasticity improved after footbath treatment in post-stroke patients on the affected side, and all F-wave parameters were lower post-treatment. Increased body temperature appeared to be the cause of the decreased F-wave parameters. Our results confirm that footbath treatment, when performed appropriately, can be applied as a non pharmacological anti-spastic treatment with little risk. The long-term benefits of this intervention warrant further investigation. P28 Observational survey of psoriasis patients under thermal treatment in Uriage-les-Bains Chanteau Sophie1, Matta Anne-Marie1, Chapalain Véronique2, Zourabichvili Othar2, Gougerot Agnès1 [France] 1 - Laboratoires Dermatologiques d’Uriage, Courbevoie 2 - Groupe Quanta Médical, Rueil- Malmaison Chanteau Sophie 98 avenue de la République 92400 Courbevoie (FR) +33 1 55 70 19 23 s.chanteau@uriage.tm.fr Background The benefits of thermal treatment in dermatology are not very well evaluated, especially for frequent dermatoses (eczema, psoriasis). A survey in this field allows the activity assessment of a thermal center, especially in psoriasis patients treatment. Objectives To assess the benefits of a thermal treatment of psoriasis patients and its impact on the quality of life at the end of the cure and at 6 months after. Methods This observational, descriptive survey (approved by CNIL) was made in Uriage-les-Bains from March to October 2008. Five doctors from the thermal center participated to this survey and used a questionnaire containing: data on patients (adults/children), medical data on the cure, medical history, initial medical data, and data on the end of the cure at day 21 (D21). Adult patients admitted to the dermatology thermal department and included in this study filled a questionnaire on the quality of life (at baseline, at D21 and at 6 months after the cure). Children between 5 and 16 years old filled a questionnaire on the quality of life adapted to their age (at baseline and at D21). Results 644 patients were admitted at dermatology thermal department in Uriage-les-Bains, 51 % of them had psoriasis (first indication in dermatology at Uriage-les-Bains thermal station). At baseline, investigators considered that 71 % of psoriasis patients had a light-moderate form of disease, 27 % a more severe form. At D21, 82 % of patients had a light form of psoriasis considered as significant improvement compared to baseline (p<0.0001). Investigating doctors considered that psoriasis was “improved” or “cleared” in 62 % of cases. Data at 6 months showed that 62 % of psoriasis patients considered the severity of their disease as “light” to “moderate”, and “cleared” or “improved” in 57 % of cases. For 59 % of patients, the medical treatment decreased after the cure, psoriasis aggravations occurred less often in 74 % of cases. The assessment of the impact of the thermal cure on the quality of life showed a significant improvement at D21 compared to baseline (p <0.0001). At 6 months, the quality of life values were the same as the values at baseline (p<0.0001). Conclusion This survey showed that psoriasis was the first indication in dermatology at the thermal center in Uriage-les-Bains. This allowed also to evidence the benefits of the thermal cure (an improvement or clearance of the disease (62 %), an improvement of the quality of life) and the benefits at 6 months after the end of the cure (outbreaks spaced in 74 % of cases, decrease of the medical treatment consumption in 59 % of cases). P29 The benefits of physiotherapy in case of Parsonage Turner syndrome Horvath Agnes, Andits Tamas
[Hungary] Horvath Agnes Fő Utca7 9700 Szombathely (HU) +36-94-515-517 hagnes47@hotmail.com The authors present a case-study about a 65 years old male patient, with sudden, very severe one-sided shoulder pain, followed by paralysis of the shoulder muscles. Based on clinical symptoms and EMG-ENG examination Parsonal Turner syndrome /PTS/ was diagnosed. In this presentation the authors demonstrate the symptoms and diagnostic criteria of PTS, a rare syndrome of unknown cause, affecting mainly the lower motoneurons of plexus brachialis. Although the patient was treated with several treatment methods, physiotherapy showed itself to be the most effective. The patient received long-term therapy, primary physico-and balneotherapy. After 12 month the patient recovered without sequal symptoms. P30 Correlation of dietary habits and activities of daily living in metabolic syndrome of rheumatoid arthritis Watanabe Tomoko1, Kon Atsushi, Aomori1, Watanabe Ichiro2 [Japan] 1 - Aomori University of Health and Welfare Graduate school of Health sciences 2 - Aomori University of Health and Welfare Graduate school of Rehabilitation and Welfare engineering Watanabe Tomoko Komagome Hotaruzawa 11-241-B21 030-0953 Aomori city (JP) +81-17-744-7646 / +81-17-744-7646 wichiro@mail2.actv.ne.jp Aims The patients in rheumatoid arthritis (RA) often need the steroid therapy, they often show the symptoms of obesity, impaired glucose tolerance, hyperlipidemia. In Japan, the new definition of the metabolic syndrome was published. Japanese definition adopted abdominal circumference over 85 cm in male and over 90cm in female as an essential component for diagnosis, and to have more than two risk factors out of three (serum fat, blood pressure, glucose level) was the definition of the metabolic syndrome. Our objectives were to survey the dietary habits of the Japanese patients with RA and to analyze their risks of metabolic syndrome. Methods The subjects were 44 outpatients with RA. The questionnaire on the physical examination, the ability to life activity and the dietary habits was used. We sort out the warning group from the normal group by abdominal circumference and compared the both. Results The patients in the warning group took significantly lager amount of steroid〔prednisolone〕than in the normal group (t-test, P<0.05). The patients in the warning group significantly ate more snacks, Japanese pickles than in the normal group (kai2-test, P<0.05). The ratio of the patients with hypertension and hyperlipidemia was higher in the warning group (kai2-test, P<0.05), and the ratio of the patients with diabetes in the warning group was also higher than that of the patients in the normal group. Conclusions Since the patients with RA often have complications such as hyperlipidemia, hypertension and diabetes, it is important for them not to eat too much for prevention of metabolic syndrome. It is necessary that we should give the patients the appropriate dietary guidance including the measures of hypertension, according to their conditions of RA. P31 Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome
 Gómez-Muniz Fernando1, Valero Raquel1, Atin Maria Angeles1, Alvarez Antonio1, Maraver Francisco2, Munoz Susana1 [Spain] 1 - Department of Physical Rehabilitation Medicine. University Complutense, Madrid 2 - Director Escuela Profesional de Hidrologia Médica. Madrid Gómez Fernando Facultad Medicina 28040 Madrid (ES) +34 656556460 rvalero@med.ucm.es Fibromyalgia (FMS) is defined as a functional somatic syndrome, where the patient suffers of chronic pain due to disturbances in pain perception pathways, probably following changes in chemical neurotransmitters. It attends with ample somatic manifestations that are usually associated with psychiatric disturbances. It is the most frequent cause of generalized chronic pain in middle age women. Pathogenic is unknown, but present data suggest pain pathways sensibilization and damaged central pain processing. Heterogeneous clinical approach and unclear knowledge of its pathogenic mechanisms leads to lack of treatment and the absence of establish protocols of performance. Hydrotherapy is often used in the treatment of fibromyalgia syndrome (FMS), however there has been limited evaluation of its effectiveness. Objective The aim of this systematic review was therefore to examine the effectiveness of hydrotherapy in the management of FMS. Methods We screened Scientific Pub Med-MEDLINE, Pedro, Cochrane Library and systematic reviews on hydrotherapy in FMS. ). Key words used 'fibromyalgia' and 'hydrotherapy', 'balneotherapy', 'aqua therapy', 'physical therapy' and 'rehabilitation' Results In pain management, only aquatic therapy seems to have long-term effects. Positive outcomes were reported for pain, health-status and tender point count. Aquatic therapy and home-based exercise programs have beneficial effects. In pain management, aquatic therapy seems to have long-term effects. P32 Comparison of different mud therapy methods in patients with ankylosing spondylitis Grozeva Antoaneta [Bulgaria] Specialized Rehabilitation Hospital, Pomorie Grozeva Antoaneta
 20 Solna Street 8200 Pomorie (BG) +359 623189 antoaneta.grozeva@gmail.com Aim To compare the therapeutic effect of different application methods of Pomorie Lake mud in patients with ankylosing spondylitis. Methods Two groups of patients with ankylosing spondylitis were compared. The first group, consisting of 49 patients received a course of 12 localised mud applications at 38-39oC lasting 15-20 minutes each. The second group, consisting of 25 patients received a course of 12 mud/salt solution (20 %) baths lasting 15-20 minutes each. Results There was evidence of improvement in 84 % of the patients in group 1, with decreased pain scores, improved mobility of the spine and affected joints, a reduction in morning stiffness and improvement in general well-being. 16 % of patients showed no improvement. 88 % of patients in Group 2 experienced an improvement, and 12 % showed no change in clinical status. There was no worsening in symptoms with either treatment. A decrease in CRP was not observed in either group. Discussion Therapy with Pomorie Lake mud in ankylosing spondylitis has an anti-inflammatory effect and leads to improvements in spine mobility and symptoms. The results of the mud bath treatment method are marginally better compared with the direct application method, although both result in symptom amelioration. P33 Clinical course of psoriasis with la Toja mineral-medicinal water Arriba Marta1, Meijide Rosa2, Mourelle Maria-Lourdes3 [Spain] 1 – Medico hidrologo, director medico balneario Hesperia isla de la Toja y Guitiriz 2 – Catedratica de EU de radiologia y medicina fisica de Universidad de a Coruña. Directora departamento de medicina 3 – Licenciada en farmacia, profesora departamento fisica aplicada de Universidad de Vigo Arribas Marta Balneario Hesperia Isla de la Toja 36991 O grove (Pontevedra) (ES) +34 986730050 / +34 691825777 direccionmedica@hesperia-isladelatoja.com 
 Introduction Psoriasis is an epidermal, proliferative, chronic, relapsing, genetically determined illness. It is clinically characterised by the appearance of erythematous dry scaly plaques that evolve in the form of outbursts. Flare-ups may be related to systemic and environmental factors. Nowadays treatment includes various therapeutic measures, none of them being curative: emollients, topical corticosteroids, keratolytic agents, tar compounds or ultraviolet light, methotrexate, oral corticosteroids and psoralene and ultraviolet light. The medicinal-mineral water from La Toja (Spain) is hyperthermal, it has a strong mineralization (30 g/L), it is radioactive and rich in calcium, iron, potassium and magnesium and it contains sodium chloride, bromine, strontium, borax and fluor. It is used for the treatment of skin conditions, specially psoriasis and atopic dermatitis, because of its therapeutic benefits. At the La Toja Spa, besides medicinal-mineral water, a thermal peloid made with mineral sediments from the spring is also used. Despite of its traditional use there are no clinic studies to support its effectiveness. We have established the aim of this study to assess the effect the thermal peloid and the La Toja medicinal-mineral water have in the clinical course of patients with psoriasis. Methodology Sample of 15 patients diagnosed with psoriasis vulgaris, aged between 12 and 50 (30 being the average age). The clinical variables, PASI (erythema, induration, desquamation and extent) and the patients’ subjective assessment of both their symptoms and their quality of life will be assessed. The treatment lasted an average of three weeks in which baths with medicinal-mineral water were taken and peloid was applied. Results After treatment, we observed improvement in the overall PASI result (average of 50 %) with a decrease in all parameters assessed in the test, a decrease in erythema, in infiltration and in scaling, skin being more moisturized and showing less desquamation. Regarding the patients’ subjective assessment, 40 % of them reported a significant improvement, 20 % a slight improvement. Our findings are consistent with those of other studies : Delfino M, Russo N, et al. [Experimental study on efficacy of thermal muds of Ischia Island combined with balneotherapy in the treatment of psoriasis vulgaris with plaques] ; Costantino M, Lampa E. [Psoriasis and mud bath therapy : clinical-experimental study]. Conclusions The La Toja medicinal-mineral water and peloid clinically improve the clinic of psoriasis, especially desquamation and inflammation. P34 Balneology (chlorided-ferruginous mineral water) in knee osteoarthritis treatment Vela Lorena1-3, Chavero A3, Rodríguez-Espinosa MP1-3, Gómez Fernando1-2, Alvarez Antonio1-2, Maraver Francisco1-2-3 [Spain] 1 - Chair of Medical Hydrology – School of Medicine, UCM, Madrid 2 - Physical Medicine and Rehabilitation. Medical Hydrology Department – School of Medicine, UCM, Madrid 3 - Lanjarón Spa, Granada Vela Lorena Chair of Medical Hydrology – School of Medicine, UCM 28040 Madrid (ES) hidromed@med.ucm.es 
 Objectives Therapeutic effects of balneology, balneology with parafango application, balneology with instant mud try to be compared in knee osteoarthritis (KOA), by a controlled, randomized, simply blind study Method 135 patients with KOA that fulfill ACR’s criteria and KOA’s radiological criteria were randomized distributed into three groups : 45 patients were treated every day, during 10 days, with parafango and Lanjarón-Salado mineral water “36-38ºC ; dry residue : 4.000 mg/L ; chloride (Cl-) : 1.474 mg/L ; sodium (Na2+) : 803 mg/L ; calcium (Ca2+) : 235 mg/L ; magnesium (Mg2+) : 67 mg/L ; sulphate (SO42-) : 129 mg/L ; bicarbonate (CO3H1-) : 756 mg/L and iron (Fe2+) : 14 mg/L” and steam bath ; 45 patients followed treatment with mud (45-47ºC) together with Lanjarón-Salado mineral water (idem) and steam bath ; 45 patients were treated with Lanjarón-Salado mineral water (idem) and steam bath only. All patients were evaluated before and after balneology (functional evaluation, BMI, muscular and joint balance, VAS pain scale, Lequesne's scale, WOMAC scale and SAR-M scale). Results Three protocols showed his efficiency by improving both symptomatology and functionality. Better results were obtained when mud or parafango. Conclusion Balneology is a good treatment for the KOA. Pain relieve and functionality improvement is seen, but better results are obtained with thermotherapy and parafango or mud association Key words : spa therapy, knee osteoarthritis, chlorided-ferruginous mineral water, balneotherapy, mud therapy P35 Experimental study on the adverse effects to the thermal spa therapy in Dax and Saint-Paul-lès-Dax Bouvier Ghislaine, Dubourg Karine, Villegas C, Cambar Jean [France] Institut du Thermalisme de Dax, Université Bordeaux 2 Bouvier Ghislaine Institut du Thermalisme, 8 rue Sainte-Ursule, 40100 Dax (FR) +33 558561942 / karine.dubourg@u-bordeaux2.fr The 18 thermal spas in Dax and Saint-Paul-lès-Dax welcomed around 60,000 patients, for rheumatology and/or phlebology therapies in 2008. We set up an epidemiologic monitoring experimental study on the patients in Dax and Saint-Paul-lès-Dax, so as to describe the adverse events which could occur during the 2009 thermal spa therapy season, and to try and highlight the factors which could help explaining their occurrence. This work is in line with a process of improvement in the knowledge of the thermal spa treatment benefit/risk ratio. We phoned or met the doctors involved in the thermal spa therapy industry in Dax or Saint-Paul-lès-Dax (48 ppl). The questionnaires and the study protocol were presented to the gathered doctors with a briefing. They were modified if necessary, to take into account the doctors’ observations. Each week, we defined a number of patients (chosen by random and representing 1/5th of the followed-up patients) for each doctor. They were given one file per patient (thermal spa treatment follow-up questionnaires, and another questionnaire bound to the patient’s GP for the post-treatment follow-up). Altogether, 13 doctors got involved to the study (participation rate = 27 %). The inclusions begun on June 13th and ended on August 23rd, 2009. We included an average number of 28 patients per doctor, i.e. an average inclusion of 37 patients per week of study. The data are currently being processed on the EpiData® software and will be analysed with the help of the Epi Info 6® software (EpiConcept, Paris, France). A preliminary analysis seem to indicate that almost all of the iatrogenic appearances reported by the doctors are benign. In addition to a description of all the reported effects, we shall also try and research to discover if some particular patients’ profiles (age, gender, treatment indications, pre-existing pathologies) are more likely to develop a specific kind of adverse effects. Keywords : thermal spa, thermal spa treatments, adverse effects, infectious hazard, epidemiologic follow-up, sanitary monitoring P36 Evaluation of thalassotherapy in relation to the treatment of fibromyalgia in comparison to the physical medicine techniques. Determination of the effectiveness and therapeutic patterns of application Morer-Liñan Carla1, Maraver-Eyzaguirre Francisco2 [Spain] 1 - MD Specialist in Medical Hydrology and Primary Care Medicine ; Collaborator UCM-Medical Hydrology School, Medical Director of Thalasia-Centro de Talasoterapia 2 - MD, PhD UCM, Chair of Medical Hydrology – School of Medicine, UCM, Madrid (Spain) Physical Medicine and Rehabilitation. Medical Hydrology Department – School of Medicine, UCM, Madrid Morer Carla Directora Médico Centro de Thalassoterapia Thalasia Hotel & Thalasso Center Avda. del Puerto, 327-329 30740 – San Pedro del Pinatar, Murcia +34 968 18 77 08 /+34 968 17 83 11 cmorer@thalasia.com The intention of this study is to evaluate the effectiveness of the thalassotherapy as helping treatment to the farmacológic treatment in fibromialgia and secondly to demonstrate that it is more effective than the prescribed protocol of physical therapy in the sanitary services of the SNS. N patients with the fibromialgia diagnosis distribute themselves randomly in 2 groups: a group with the therapeutic intervention thalassotherapy (n/2), that will make 15 sessions of thalassotherapy and a control group (n/2), that will make 15 sessions of physical therapy. In this pilot observation study we try to calculate N with a first group of 20 patients with an estimated 50 % of improvement in both groups. Alfa Risk 5 % and Beta Risk 20 % and 15 % drop out. The effectiveness of the therapeutic intervention to study will be evaluated by means of the statistically significant improvement in the physical and mental health of the patients by means of the Questionnaire of the Impact of the Fibromialgia (Fibromyalgia Impact Questionnaire [FIQ]) and of the pain in Visual Analogical Scale (EVA). Key words : Balneology, Thalassotherapy, fibromialgia, spa therapy References 1. Hidrología. BOE núm 220 de 13 septiembre 1988:27074-27076. 2. Decreto 55/1997, de 11 de julio, sobre condiciones sanitarias de Balnearios, Baños Termales y Establecimientos de Talasoterapia y de aplicación de Peloides. Boletín Oficial de la Región de Murcia, de 28 de julio 1997:8677-8685. 3. Armijo M, San Martín J. Curas Balnearias y Climáticas, Talasoterapia y Helioterapia. Madrid, Ed. Complutense, 1994. 4. Maraver F. Talasoterapia. En: Rodríguez LP (edit). Técnicas Hidrotermales. Madrid, Ed. Videocinco. 2000:151-163. 5. AETS. Técnicas y Tecnologías en Hidrología Médica e Hidroterapia. Madrid : Instituto de Salud Carlos III, 2006. 6. Martín AI. Contraindicaciones del termalismo. En: Maraver F (dir). Vademécum de Aguas Mineromedicinales Españolas. Madrid : Instituto de Salud Carlos III, 2004:37-45. 7. Alegre C, Pereda CA, Nishishinya MB, Rivera J. Revisión sistemática de las intervenciones farmacológicas en la fibromialgia. Med Clin (Barc) 2005;125:784-7. 8. Nishishinya MB, Rivera J, Alegre C, Pereda CA. Intervenciones no farmacológicas y tratamientos alternativos en la fibromialgia. Med Clin (Barc) 2006;127:295-9. 9. Ardiç F, Ozgen M, Aybek H, Rota S, Cubukçu D, Gökgöz A. Effects of balneotherapy on serum IL-1, PGE2 and LTB4 levels in fibromyalgia patients. Rheumatol Int 2007 Mar;27(5):441-6. 10. Evcik D, Kizilay B, Gökçen E. The effects of balneotherapy on fibromyalgia patients. Rheumatol Int. 2002 Jun;22(2):56-9. 11. Dönmez A, Karagülle MZ, Tercan N, Dinler M, Işsever H, Karagülle M, Turan M. SPA therapy in fibromyalgia : a randomised controlled clinic study. Rheumatol Int 2005 Dec;26(2):168-72. 12. de Andrade SC, de Carvalho RF, Soares AS, de Abreu Freitas RP, de Medeiros Guerra LM, Vilar MJ. Thalassotherapy for fibromyalgia : a randomized controlled trial comparing aquatic exercises in sea water and water pool. Rheumatol Int 2008 Dec;29(2):147-52. 13. Altan L, Bingöl U, Aykaç M, Koç Z, Yurtkuran M. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int 2004 Sep;24(5):272-7. P37 Hydrotherapy and management of osteoarthritis of the knee Santos Ana, Peixoto Pedro, Pires C [Portugal] Hospital do Divino Espirito Santo Santos Ana Rua Nova do Visconde, nº100, 2º Dto Tr 9500-337 Ponta Delgada (PT) +351 913454378 anin_has@hotmail.com Introduction The prevalence of osteoarthritis is increasing in our society at the same rate that aging of this population occurs. This has a growing social and economic impact in our society including employment issues like loss of working days and decreased productivity. For that it is very important to provide the best treatment, physical function and quality of life possible to those patients. Methods At the present there is no curative treatment, pharmacological or non-pharmacological, and pain control and reduction of functional restriction are the main aim of our intervention. Besides medication and weight reduction, conventional physiotherapy and exercise therapy are very important in the management of osteoarthritis of the knee. The latter two have shown, at a high level of evidence, to be cost-effective and to have long-term benefits for pain relief, movement in the affected joint, and patient quality of life. However, hydrotherapy for osteoarthritis of the knee has shown in several studies to better improve range of movement and pain reduction, with enhanced sense of well-being and increased quality of life, highly valued by these patients. Conclusion Hydrotherapy, land-based exercises and pharmacological therapies all reduce pain and increase function in patients with osteoarthritis of the knee but hydrotherapy seems to be superior at least to land-based exercises in relieving pain before and after walking, associated with persistent improvement in pain, analgesic and non-steroidal anti-inflammatory, drug consumption. Also it has much lesser side effects than medication. It is a noninvasive, reasonably priced, therapeutic option in the concomitant treatment of osteoarthritis of the knee. Therefore it is a suitable and effective alternative for the management of this disease. However, the scientific evidence is weak because of the poor methodological quality of many studies and the absence of an adequate statistical analysis and data presentation; more studies are therefore needed to support current findings. P38 Complex regional pain syndrome type I treatment and hydrotherapy Santos Ana, Peixoto Pedro, Pires C [Portugal] Hospital do Divino Espirito Santo Santos Ana Rua Nova do Visconde nº100, 2º Dto Tr 9500-337 Ponta Delgada (PT) +351 913454378 anin_has@hotmail.com Introduction Complex Regional Pain Syndrome (CRPS-I) appears to be a regional neurovegetative disturbance, which overall clinical appearance seems to be dominated by a dysfunction of the sympathetic nervous system, resulting in vasomotor and trophic disorders of the affected limb, with local severe burning pain, swelling, increased sweating, changes in skin temperature and color, softening and thinning of bones, joint tenderness or stiffness, and restricted or painful movement. Injuries seem to be the most common cause, especially in the lower limbs and may be associated with fractures, sprains, simple injuries, use of casts and after surgery. Methods The treatment of this condition is complex and is subject of discussion. It may include pharmacological therapy and physical therapy, and investigators are currently studying new approaches to treat it and intervene more aggressively. Physicians use a variety of drugs to treat CRPS-I, including antidepressants, anti-inflammatory drugs, corticosteroids, bisphosphonates, vasodilators, GABA analogs, adrenergic-blocking compounds, and opioids, but there is not much supportive evidence for most of them. In order to decrease pain and functional limitations, several physical therapy strategies and techniques, including range-of-motion exercises, are commonly used with success. Furthermore, hydrotherapy, including contrast baths and whirpool baths, seems to be helpful reducing pain and sweelling in the affected limb with great efficacy in reducing stiffness and promoting better range-of-motion of the affected joint as well improvement of local trophic changes, with good acceptance by the patient, resulting in a better outcome when associated with the other treatments. Conclusion In association to other therapeutic strategies, hydrotherapy may be an effective approach to the treatment of CRPS-I, through the use of the physical properties of water like buoyancy of water, resistance and even it’s temperature, either cold or warm. Still the effects of hydrotherapy in the relief of CRPS symptoms have rarely been subjected to rigorous assessment and should be subjected to further investigation in randomized controlled clinical trials which would surely be useful in the future. P39 Aquatic therapy in osteoporosis : a systematic review Olabe-Sanchez Pablo1, Canelas Olga2, Meijide Rosa3, Maraver-Eyzaguirre Francisco4, Delgado-Rodriguez Miguel5, Martinez-Almagro Andreas1 [Spain] 1 - Universidad Católica San Antonio de Murcia 2 – Servicio médico - Balneario de Archena 3 - Universidad de A Coruña 4 - Universidad Complutense de Madrid 5 - Universidad de Jaén Olabe Sanchez Pablo C/ Alcaraván s/n, Portal 8, 2ºA 30740 San Pedro del Pinatar, Murcia (ES) pablo_olabe@hotmail.com Introduction and aims The health status and daily living activities could be influenced by a series of consequences derived from osteoporosis. Nowadays Hydrology suggests different ways to face the symptoms and signs of this pathology. On the other side, physical therapy shows the use of an aquatic environment as a therapeutic tool which let us to employ its properties to get benefits in the rehabilitation of a patient. This aspect is based on its physical principles: mechanic, thermal and chemical. Therefore, we consider the need of determining the scientific evidence we could find in articles which show a relationship between the aquatic therapy and its repercussions in prevention and treatment of osteoporosis. Method We performed a systematic review through an electronic search in Cochrane Library Plus, EBSCOHost, Medline, OvidSP, PEDro, Teseo and Web Of Knowlegde. We selected all articles which developed an aquatic therapy programme in people with osteoporosis. In addition, the Aquatic Physical Therapy Journal was explored manually. Once finished this process, we evaluated the methodological quality and evidence level of the articles we get. All the process was made in June/July 2009. Results The inclusion process retrieved a result of 10 articles. The methodological quality of them was different (3 high quality ; 6, quality enough ; and 1, poor quality) as well as the evidence level (most of them get a level I and II) according to the North of England evidence-based guideline development project. Conclusions In accordance with this review, most of the articles showed an effective result once an aquatic therapy program is applied to react to the osteoporosis, specially located in postmenopausal women. Key words Aquatic therapy and osteoporosis. Techniques P40 Thermal Spa 2009 in Royat and cognitive functions of old drivers : Preliminary report of the first study about 238 cases. Avril PB, Avril P, Dauzet H, Calas F, Body Jacques, Eyboulet G, Caillot NR, Meyer JL, Schmidt Jeannot [France] Institut de Recherches Cardio-Vasculaires de Royat-Chamalières Avril Pierre 18 bis Boulevard Barrieu 63130 Royat (FR) +33 4 73 35 85 41 / +33 6 07 13 09 70 avril.p@wanadoo.fr The increase in life expectancy goes hand in hand with the wish to be self-sufficient the longest possible time and therefore, for most persons having hydrotherapy, to be able to drive their cars. At the moment, a threat hangs over the 75 years old and more old drivers to have to undergo an exam by their doctor to be able to carry on driving and this age is reduced from 75 to 70, or even to 65 in other countries. Now, we know that the cerebral ageing is far from being related to calendar ageing and this notion, confirmed since 1981 by the “retroactive visual masking” that we have been using use since twenty years has been taking up since two years by the Pr Denys Pellerin in his “new aspect of age” (Royat, 2008). The action of the course of hydrotherapy in Royat on the arterial circulation of lower limbs being established in an express way by recent works, it is interesting to study its posssible action on cerebral function with the help of psychotechnical tests used in the removal of driving licence. Actually, whatever the age, driving requires a minimum of “mental performances” defined for 15 years by “Auvergne Psychométrie”, Psychotechnical Center approved by the Prefecture, which has put at Royat disposal its four tests of awakening vigilance grouped together in a CDRom called “ROYATests4®” and associated to the possibility to make a clock drawing test, exam asked by some countries to old drivers. These computerized tests are the Retroactive Visual Masking (MVR / RVM), the auditory reaction time (TRA / ART), the visual reaction time (TRV / VRT) and the squares test (TC / ST). Study targets - To work out the situation of a sample group of 70 years old or more drivers in relation to various criteria (tests, pathology leading to the course of hydrotherapy, accidentology, medicine) - To evaluate the immediate action of the course of hydrotherapy - To study the persistence of the effects in 3, 6 and 9 months - In 2010, to appreciate the results in one year. Equipment and method After a presentation of the method, which was meant to be multicentric, at the French Society of Hydrology in January 2008, a mailing maked in January 2009 with 10000 persons having hydrotherapy (average age, 69 years old) and calling the drivers of 70 years old and more, has collected 363 favourable responses, 238 of whom have actually contributed. The four tests have been made 2 or 3 days later in a determined order : MVR1, TRV, TRA, Carr TC et MVR2. Then, again, 17 or 18 days later. A CDrom has then been handed in to participants in order for them to be able to test themselves later before 3, 6 and 9 months to assess the persistence of the effects, the result one year later being scheduled for 2010. Current results - On our first objective, we can say that 75 % of them are within the “norms” to drive. - On the second objective, the course of hydrotherapy normalizes more than 30 %¨of those who were out of norms to the arrival but it can have also a beneficial effect for those who were normal. Discussion If the real improvement of cognitive functions during the course of hydrotherapy is statistically proved, it would make of Royat the real “cerebral anti-age”, the treatment which is able to prevent from and to put off the apperance of irreversible cognitive troubles and to improve the security of old drivers. Key words : new method, prevention, old drivers, Royat, IRCV, cognitive functions, visual reaction time, auditory reaction time, retroactive visual masking, squares test, Thermal spa of Royat. P41 Study of the characteristics and properties of Thalasia’s (Murcia) salt water peloid Armijo Francisco1-2, Morer C1-2-3, Corvillo I1-2, Maraver Francisco1-2 [Spain] 1 - Chair of Medical Hydrology, School of Medicine, UCM, Madrid 2 - Physical Medicine and Rehabilitation. Medical Hydrology Department School of Medicine, UCM, Madrid 3 - Thalasso Center, Thalasia, Murcia Armijo Francisco Chair of Medical Hydrology – School of Medicine, UCM 28040 Madrid (ES) hidromed@med.ucm.es Introduction First of all, we must point out the boom of thalasso centres situated on the spanish coasts. Thalasia is the only Spanish thalasso center that prepares salt water peloid from clay and Mediterranean salt water “dry residue : 78.066 mg/L ; chloride (Cl-) : 41.474 mg/L ; sodium (Na2+) : 23.297 mg/L ; calcium (Ca2+) : 391 mg/L ; magnesium (Mg2+) : 2.823 mg/L ; sulphate (SO42-) : 6.497 mg/L ; bicarbonate (CO3H1-) : 122 mg/L and potassium (K1+) : 1.025 mg/L”. Objective The objective of this paper is to study the physical properties of the salt lime mentioned that has 60 % water. Material and Method Peloid samples taken directly in situ and transported to the Professional School of Medical Hydrology. The parameters analyzed : % solid components, water content, ash, texture and temperature curve. The calorific capacity, thermal conductivity coefficient and calorific retention were calculated from these figures. The techniques used : gravimetric, Stevens texturometer and Rambaud method for the temperature curve. The ATP test, selecting the Hardness, Cohesive, Adhesive and Elasticity parameters, was used for texture determination. Conclusion The figures obtained leed us to conclude that the peloid under study contains 60 % water and 30 % ashes. The texture values make us consider this peloid as one of low hardness and adhesion and high cohesion Key words : thalassotherapy, mud therapy, salt water, peloid P42 New experimental methods for studying potential toxicity of peloids Gerencser Gellert, Szendi Katalin, Muranyi Edit, Varga Csaba [Hungary] Department of Public Health Medicine, University of Pécs Gerencser Gellert Szigeti 2 7624 Pécs (HU) gellert.gerencser@gmail.com Hungary is one of the world’s few countries which has considerably rich sources of spa waters and peloids. The country has several some 1300 spa waters and four registered peloids. The objective of the present study is to detect the possible toxic and genotoxic effects of peloid compounds. Our previous ecotoxicological experiments were carried out on lower organisms to test toxicity. From the results of these tests we concluded that muds could possibly contain components which were harmful for lower organisms. Comet assay (Single Cell Gel Electrophoresis) is used for the examination of potential genotoxic environmental components. It is adequate for all eukaryotic cell types. We used earthworm coelomic cells as a special exposure model. The aim of the present study is to find analogy between the test results of the lower organisms’ cells (earthworms) and human cells in comet assay. The results of these new experiments would be appropriate in tests on lower organisms’ cells instead of human cells in comet assay. P43 Methodological development of genotoxicity studies comparing peloids and contaminated soil samples using Ames test Szendi Katalin, Gerencsér Gellert, Murányi Edit, Varga Csaba [Hungary] Department of Environmental Health, Institute of Public Health Medicine, University of Pécs Szendi Katalin Szigeti 12. 7624 Pécs (HU) +36 72 536394 / +36 70 2654095 szkata82@yahoo.co.uk The mode of action of peloids (medicinal muds) applied in spa therapy has been mostly unknown, especially in aspect of chemical features. Most of the information we have are just on the inorganic salts. Recently several organic compounds have been detected from spa waters using gas chromatographic methods, without exact knowledge on biological activity. They may have important roles in therapy, but carcinogenic and other toxic properties, as well. This aim requires severe methodological development in this field. In the present paper two peloid samples from Hévíz (West-Hungary) and Kolop (East-Hungary) were compared with a contaminated soil sample containing high amount of organic compounds. Aqueous, hydrochloric acid, methanol and toluene extracts were performed from peloids and soil sample before using Salmonella Ames test. The assay was performed both in the presence and absence of standard rat liver S9 mix used for the metabolic activation. Applying TA98 strain for detection of frameshift mutations and TA100 strain – sensitive to base-pair substitution – few positive responses were observed. P44 Present interest topics in the therapy with peloids in Romania Nica Sarah Adriana [Romania] University of medicine and pharmacy « Carol Davila » Ciocan Madalina, National institute of rehabilitation, physical medicine & balneoclimatology Mitoiu Brindusa Ilinca Bdul Ion Mihalache no 11A 011171 Bucharest Romania adisarahnica@yahoo.com Background From ancient times, different types of mud were used for therapeutic purposes. The term peloid is used to describe a substance formed in natural conditions under the influence of the geological processes and which in fine divided homogenous state with or without a combination with water can be used in medical practice as bath or local procedures. The peloids in Romania can be classified in sapropelic mud and peat mud. Sapropelic mud (sulfated and black colored) include : mud from the bank and seaside lakes (Techirghiol, Agigea), mud from continental lakes (Amara, Caieni, Lacul Sarat), fossils mud (Ocna Sibiului), mud from sulfated springs (Sacelu - Oltenia), mud from the Black Sea. Peat mud (organic and brown colored, like Poiana Stampei, Borsec), including vitriolic peat (Stobar). There is also a class of mineraI mud deposited by non-sulfated springs (Sangeorz). After a modern concept, peloids represent a heterogeneous physical-chemical system formed from a liquid phase and a solid phase (crystal structure and colloidal complex). Aims Our paper wants to reevaluate the place and role of therapeutic peloids in general and rehabilitation therapy and its particularities in Romania. Material and method We wanted to differentiate the mud profile in sorne specific areas. After we established the chemical type of the peloid, we moved to the systematic analysis, using various solvents to extract every group. The mineraI analysis consisted in the analysis of the liquid and sol id mineraI phases. For the mud from the bank, seaside lakes and continental ones an analysis of the lake had also to be done. Each peloid was explored from physical and chemical point of view as weIl as from the therapeutic one. Results and conclusions the peloids, considered a heterogeneous organic and mineraI complex, with defined physical particularities, receive through microbiologie and probably cyclic activity, a state of dynamic equilibrium in the natural reservation. We can affirm that the transformations suffered by material under physical, chemical and microbiological factors are usually the same and the y lead to a good balance between consumption and generation, which from macroscopic point of view is not very easy to be detected. Extracting the peloids from their natural environment and introducing them in a circuit can lead to a lack of balance by increased mineraI and organic consumption. Still, the initial features are usually the ones to decide the dimensions of the processes, their limits and significance. So, in peloid therapy we must always take into account the combined action of aIl the physical and chemical factors. The therapeutic effects of the peloids are weIl recognized and various aspects of their actions open new opportunities for research in the area. The important therapeutic effects offer also excellent ways to treat patients as part of the complex rehabilitation program. Key words : peloid, therapy, sapropelic mud, peat mud, rehabilitation program Education & information P45 Reflection on the relevancy of professional bridges between jobs in the fields of thermalism, public health and individual assistance Lacouture Éric1, Berot Olivier2, Roubertou Anne3 [France] 1 - Institut du thermalisme – Université Bordeaux 2. 2 - Greta des Landes (Dax) 3 - Greta du Limousin (Limoges) Lacouture Eric Institut du Thermalisme 8 rue Sainte-Ursule, 40100 Dax (FR) +33 558561942 / +33 685945764 eric.lacouture@u-bordeaux2.fr During those last years, the profession of hydrotherapist truly developed : it is no longer reduced to the application of a simple hydrotherapy technique but also has to take into account regulations, sanitary and even quality issues. Today, those different issues are included in the programs of all the existing trainings and it seems that they have many similarities with professional careers in the field of public health and individual assistance. We propose to lead a real work of investigation, gathering all professionals of the fields of thermalism, public health and individual assistance. Our objective is to check existing similarities between training programs and skills. Beyond this investigation, it would allow an important work of reflection with different ministries or professional branches, in order to determine the feasibility and the conditions of the implementation of the recognition of the hydrotherapist profession. This implementation is related to the access of professional careers in the field of public health and individual assistance (those conditions concern dispensation of modules or entire trainings, complementary modules, complementary exams). In the event of a relevance of professional bridges between thermalism, public health and individual assistance, hydrotherapists would benefit from opportunities to maintain their activity throughout the year, while strengthening their field of skills. Key words : Thermalism, Public health, Individual assistance, skill, Professional bridges P46 Training offer and international dimension Lacouture Eric, Tran Van Chuoi Odile, Bouvier Ghilaisne, Dubourg Karine, Laplace D, Cambar Jean [France] Institut du thermalisme - Université Victor Segalen Bordeaux 2 Lacouture Eric Institut du Thermalisme 8 rue Sainte-Ursule 40100 Dax (FR) +33 558561942 / +33 685945764 eric.lacouture@u-bordeaux2.fr The Institut du Thermalisme is a unique French university structure, thanks to its belonging to the Victor Segalen Bordeaux 2 University, which may deliver trainings regarding health waters and thermal spa treatment, from baccalaureat (A-Level) to vocational master’s degree. Concerned as we are to abide by the Licence/Master’s/Doctorate system currently in use on the European scale, the Institut du Thermalisme proposes state degrees : • For the Doctorate level, a Capacity in Hydrology and medical Climatology. A unique training proposed to GP who wish to exercise thermal medicine ; it is provided under the responsibility of Pr B. Bannwarth – Therapeutics Laboratory (Bordeaux 2 University). • For Master’s level, a vocational Master’s The Vocational Master’s degree –Pharmaceutical and Health Products – Environment Health Waters – has been training capable executives since 1993, in the management of health problems linked to water, in reference to technological and regulatory skills. • For the Licence (Bachelor’s degree) level, 2 vocational Licences The Vocational Licence – Protection of the Environment – Technologies and Management of Health Waters- is aimed at higher technicians to acquire specific knowledge in designing and maintaining inner water networks. The Vocational Licence – Hotel and Catering Management – Management of Health and Well-Being Water Farms. It cares to train managers specialised in thalassotherapy, spa fun, balneotherapy spa, hotel or holiday resort spa. In the field of vocational training, the Institut du Thermalisme also proposes several two-year University Degrees which focus on the main jobs met within a thermal spa. • Hydrotherapy Activities Management • Nurse in thermal spa environment • Physiotherapist in thermal spa environment • Hydrotherapy Treatment Finally, The Institut du Thermalisme punctually proposes : • Adult continuing education days in the field of thermal medicine, and within the framework of the Capacity in Hydrology and medical Climatology, • Adult continuing professional education, either on-site or in the thermal spas. In the perspective of a wide pedagogical opening to International Relations, the Institut du Thermalisme has established various contacts with foreign countries over the past few years. Many of these contacts with universities and thermal spa professionals went official in partnerships through framework agreements or the Erasmus programme. They opened the way to the developing of student and teacher mobility. P47 TERMARED – European Thermal Spa Network - European Programme INTERREG-IV - SUDOE Tran Van Chuoi Odile1, Cambar Jean1, Legido-Soto Jean-Louis2, Carvalho JM3, Gerbaud P4, Machado A5, Pardo C6 [France, Spain, Portugal] 1 - Institut du Thermalisme, Université Victor Segalen Bordeaux 2, France 2 - Applied Physics Department, Sciences University, Vigo University, Campus Lagoas-Marcosende s/n, 36310 Vigo, Spain 3 - Cartography and Applied Geology Laboratory, Geotechnics Engineering Department, Advanced Engineering Institute of Porto, Portugal 431 du Dr António Bernardino de Almeida Street, 4200-072 Porto, Portugal 4 - Economical Action Management, Conseil Général des Landes, France 23 rue Victor Hugo, 40025 Mont-de-Marsan, France 5 - Association for the development of the Alto Tâmega Region, Avenida da Cooperação, Edifício Inditrans Lt A1 Nº 2, 5400-673 Chaves, Portugal 6 - Xunta de Galicia - Consellería de Innovación e Industria, Dirección Xeral de Turismo, Praza de Mazarelos, Nº 15, 1570, Santiago de Compostela, Spain Tran van Chuoi Odile Institut du Thermalisme 8 rue Sainte-Ursule, 40100 Dax (FR) +33 558561942 / +33 678986318 odile.tranvanchuoi@u-bordeaux2.fr Launched in 2009, TERMARED is a thermal spa network which gathers the regions from the South-western Europe having a vast thermal-spa tradition, and a great available richness in natural mineral waters resources. TERMARED aims to strengthen the interregional cooperation as it would ease exchanges, innovation and knowledge transfers between the thermal spa and thalassotherapy centre (sea spas) associations. The task group dynamics enables us to set up initiatives promoting thermal spa treatments. These initiatives are numerous : the creation by partner countries of a catalogue of the thermal springs with interesting and original therapeutic properties, the realisation of a second prototype named “Pilote Eau Thermale” (Thermal Water Experimentation) made with PVC-C (over-chlorinated polyvinyl chloride) and its use by the thermal spas of the countries collaborating in sanitary hazard management, the promotion of thermal mud in Galicia, a study on the influence of climatic changes on thermal waters resources, the creation of an Internet site devoted to the matter. During and after the project execution in late March 2011, the aim of this partnership is also to promote actions in support of the new opportunities of cooperation with other institutions so as to extend the impact of TERMARED on the long range. Keywords : European thermal spa network – thermal spa treatment promotion – exchanges – knowledge transfers P48 Critical analysis of the medical hydrology articles published on the journal Voprosy Kurortologii Fizioterapii i Lechbenoi Fizicheskoi Kultury in the last 5 years Graña N, Arranz JL, García-Sánchez M, Párraga-Marinas E [Spain] Professional School of Medical Hydrology – Faculty of Medicine, UCM, Madrid Graña Narciso Professional School of Medical Hydrology – Faculty of Medicine, UCM 28040 Madrid (ES) +34 91 394 16 67 hidromed@med.ucm.es Introduction We were greatly surprised when in a recently published article about investigation in Medical Hydrology [1], we find out that they emphasize that in biomedical data base MEDLINE, the scientific publication with more number of Medical Hydrology published Works in the last five years was a Russian one, specifically Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury (VKLF) Journal. The objective of the present work is to execute a critical study about the articles on Medical Hydrology published by the mentioned journal in the last five years, through the multifactor analysis of the scientific studies` quality. Material and Methods We carried out a PubMed research whose limits were: • Russian • Vopr Kurortol Fizioter Lech Kult AND Balneotherapy OR Balneology • With abstracts • Published the last 5 years We found 69 articles indexed. Subsequently we request the articles to the Complutense University, Faculty of Medicine, Interlibrary Service, proceeding to their translation and evaluation. For the evaluation of the articles we use the RATS checklist modified by BioMed Central [2] from the work of Jocelyn Clark (Clark JP : How to peer review a qualitative manuscript. In Peer Review in Health Sciences. Second edition. Edited by Godlee F, Jefferson T. London: BMJ Books ; 2003:219-235). Also we use the CONSORT group checklist [3]. Once do the first contact with the articles, we give points to the different parameters of the RATS checklist, slightly modified for adjust to all the articles. We also based on scientific evidence levels tables, specifically in the scientific evidence quality levels created by the Agency of Evaluation in Medical Technology [4] and in the recommendation grade of the Based Medicine Centre of Oxford University [5]. Results-Discussion We must have to remark two points : first, the redaction is a little different that the usual practice, because there is not a clear subtitles organization, but a continuous redaction. Even that division do not exist, in the redaction are included all the items of a scientific publication: Introduction, Objectives, Material and methods, Results, Discussion, Conclusions and Bibliography, and, second the English abstracts are to plain, hardly given an introductory information. The major part of the evaluated articles was case control studies also there were cohort studies or clinical trial studies. We objectify fails on the details of how recruitment was conducted, a clear description of data collection and the explanation of the statistical method used. By other side, practically all the articles have a great content relevance having a B-C recommendation grade and a quality levels that flows from III to VII over IX. So we conclude that the VKLF journal has a good recommendation level and a good scientific quality, although it can improve in some points. We consider that is very important for the physicians that do balneology can get access to the information that this journal offer. Key words : Vopr Kurortol Fizioter Lech Kult, Balneotherapy, Balneology Acknowledgments The authors want to be grateful to Tetyana Tkachenko Abramova and Mª Teresa Diaz Berenguer for the effort executed in the translation of the articles. Also we want to thank Mª José Valdemoro Fernández-Quevedo, person in charge of the Complutense University, Faculty of Medicine Interlibrary Service for her invaluable help. Bibliography 1. Maraver F, Morer C. Investigación PubMed y Termalismo. In : Maraver F, Armijo F. Vademecum II de aguas mineromedicinales españas. Madrid : Universidad Complutense ; 2010:31-42. 2. BioMed Central. Qualitative research review guidelines: RATS. [cited on 2008 Mar 1]. Available from: http://www.biomedcentral.com/info/ifora/rats. 3. Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996;276(8): 637-9. 4. Jovell AJ, Navarro-Rubio MD. [Evaluation of scientific evidence]. Med Clin (Barc) 1995;105(19):740-3. 5. CEBM. What is EBM ? [homepage on the Internet]. Oxford : Centre for Evidence-Based Medicine [updated 2009 Nov 20; cited 2010 Feb 15]. Available from: http://www.cebm.net/ P49 La formation... une nécessité à tous les niveaux Boucherie Jessika, Brichet Joris, Schelsohn Fabrice [France] Centre de Formation du Thermalisme et de la Biologie Thonon-les-Bains Schelsohn Fabrice Centre de formation du Thermalisme et de la Biologie BP 80074 5, avenue du Léman, 74202 Thonon-les-Bains (FR) +33 4 50 17 04 23 fabrice.schelsohn@ac-grenoble.fr Il est indispensable que tous les acteurs de l’hydrothérapie puissent avoir accès à la formation. Cette formation doit être scientifique et évolutive. Elle doit être axée sur le triptyque de : - la qualité des soins et de l’eau en hydrothérapie, - la gestion durable de la ressource en eau minérale naturelle, - l’environnement économique et social. Tous les acteurs de l’hydrothérapie sont concernés : l’agent de service thermal, le personnel de santé, le technicien, le manager. L’enjeu est important : si les établissements d’hydrothérapie mettent en place du personnel formés alors ils seront crédibles, reconnus et pourront affronter sereinement le XXIe siècle avec ses certifications et ses accréditations. P50 New European certificate at the field of thermalism “Thermal agent” Angelova Tatyana, Dimitrov Preslav*, Kaneva Tsvetelina, Stoycheva Maria [Bulgaria] National Hospital for Physical Therapy and Rehabilitation, Sofia *South-west University “Neofit Rilski” Blagoevgrad Angelova Tatyana blv. Ovcha kupel 2 v 1618 Sofia (BG) tan_angelova@yahoo.com The Project No 134098 - LLP - 2007-BG- LMP “creation d’une certification européenne d’agent thermal” / acronyme : THERM / is worked out according the rules and criteria of Lifelong Learning Programme – Leonardo da Vinci. Consortium of three countries - Bulgaria, France and Romania is made. There are partners of each country representatives of : • the economic sector of thermalism ; • associations at the field of balneology and spa ; • universities ; • educating institutions with experience at its methodology and organization. The goal of the project is to create a certificate according the European educational criteria, valid for the three countries. The duration of the project is from January 2008 to April 2010. The working plan includes three steps: overview of the real situation at each country – partner ; creation the new European certificate through the method of competence approach; working out a programme for instructors/trainers for the education teams. Many common problems at the three countries are found : • increase of expectation of the patients/ clients concerning: attitude of welcoming, cares for good condition etc.; • progressive decrease of the expenses for balneal care of health insurance institutions ; • necessities for adaptation the balneal activities, especially medical services according to the needs of the society – aging, chronic diseases, obesity, hypodymania etc. All these problems need development of the professional manners and knowledge of the thermal agents (common name to the staff, which make balneal, peloid, thalasso and other thermal procedures at the balneotherapeutic hospitals, balneal hotels, SPA-hotels, SPA-centers etc.). This staff is in constant and close contact with the clients/patients and it is the only category nonqualified personnel working at the balneal sector. At the three countries does not exist unified wholly approved qualification and education for their duties. There are countries where the job of the thermal agent is a season one. The unified educational units would allow to be found links to other jobs with close knowledge and skills. Having double qualification season worker would be employed through all the year. The worked out new certificate is based on the European frame of certifications, recommended by the European commission and it is already included at the national procedure for professional certification and education of the country-partners. The documents and handbooks made during the project aim to help the European education and professional learning at the field of thermalism. P51 Termas world, 10 years of communication on the internet : “Submerge yourself in the Culture of the Water” Vergnes Philippe, Suarez-Santos MariaTeresa, Souto-Figueroa Maria G, Diaz Meco FJ [Spain] Department of Thermalism, Grupo Termas, Valencia Vergnes Philippe 28 rue Rouget-de-Lisle 32000 Auch (FR) +33 5 62 05 22 94 / +33 6 42 10 13 90 pvergnes@wanadoo.fr Aim Under the slogan “Submerge yourself in the Culture of the Water” TERMAS WORLD, the first electronic Magazine to be published on Thermalism and Thalasotherapy, was created in September 1999 to expand the use of new information technologies (Internet) to spread knowledge of the curative effects of mineral-medicinal waters, promoting a new concept of water for the patrimonial good and as a tourist health resource. Materials The interactive publication has its own domain (www.termasworld.com) and it is supported by professional and scientific experts that comprise the foundation team of Spain, France, Germany and Portugal. The web is divided into thematic areas of interest : Thermal News update ; Bibliographical Database for consultation ; Guide of the main Spas and Hotels ; SPA & Resorts of the world ; Thermal Tourism, where the trips become the best therapy to avoid stress ; Thalasotherapy or the power of the sea ; Thermal Aesthetics, with the latest trends in thermal and marine cosmetics ; the Club of the Friends Thermal Baths and the Thermal News Magazine. Development In 2000 the web joined synergies with Buscasalud.com for the publishing of the first interactive series under the name Healthy Routes, designed to promote tourism, leisure and health through refreshing itineraries that we initiated travelling the length and breadth of Hungary, and later Andorra, France and Spain. In 2001 this model of alternative tourism to combat stress aroused the interest of countries such as Argentina, being invited to present their scientific communication in the first National Congress of Tourism of Health in the city of Rio Hondo. Recognized also by their cultural interest, the name of Healthy Routes would soon be divulged over the Internet for the promotion of other tourist segments. Termas World is consulted by thermalism students, spas, health professionals (physiotherapists) among others, and assiduously informs of the congresses carried out by scientific societies. It also publishes works and researches on thermalism and thalasotherapy carried out in Universities. As a specialist magazine it has been recognized by prestigious Scientific Societies of Europe and Latin America. Conclusions 1. Developing the scientific thermal and tourist journalism, we actually make real the fact that to have presence on the network, it is necessary to be able to communicate. 2. With our slogan of always, “Submerge yourself in the Culture of the Water”, offering to all the internet surfers our more valued goods, the healthy exercise of reporting with rigor and professionalism generating over 30 million downloads of files, articles and scientific works. 3. As the years go by we are pleased to observe that our concept of the global village of Internet is today an indispensable tool for the Thermalism and the Tourism of Health spreading and study. 4. If throughout history we have known the meaning of thermal water, today modern society knows the importance and curative effects it offers. It exercises great care to protect water for the patrimonial good. Keywords : termas, world, submerge, culture, water, articles, patrimonial, internet, therapeutic, tourism, magazine, health, healthy, routes, internet surfers, thermalism