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C. F. Roques
 

C. F. Roques

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    C. F. Roques C. F. Roques Presentation Transcript

    • Pr CF ROQUES LATRILLE MD ISMH General Secretary AFRETH Scientific Committee President (Paris) Institute of Thermalism President (Dax)
      • Cares to the tourists
        • First aid +++
        • Primary cares GP
      • Care to the migrant returning home for holidays
        • Secondary cares (recourse advices +++)
      • Cares using natural therapeutic resources
        • Climatotherapy
        • Thalassotherapy
        • Medical Balneotherapy (medical cares delivered in thermo-mineral resorts)
      • High technology cares delivered to better costs
        • Dental cares
        • Medical Assessment
        • Cardiac surgery
        • Grafts, …
    •  
      • 104 resorts, 1200 mineral springs, 500 doctors
      • 2009 : 493 153 persons
        • 9 073 807 days for medical treatment(Social Security pays)
        • 490 889 days for wellness
      • Female : 64 % ; male : 36 %
      • Age : above 60 : 65 % - under 16 : 7 %
      • Aetiology : Rheumatic conditions = 72 %
      • Gross product of spa resorts : 1 Billion €
      • Social security involvement (thermal cares + doctors fees) : 290 Millions €
      • Employed persons : 110 000
      • Made of
        • Hydrothermal cares
        • Complementary cares (medical, paramedical, patient education, …)
        • Resort stay
          • Climate
          • Rest
          • Social interactions
          • Adapted physical activities, …
      • With Consequences on
        • Care delivery
        • Scientific investigation, …
      • Medical benefit assessment ++++
      • Preclinic investigation ++
      • Safety studies +
      • Specificity of thermo-mineral products ++
      • Medico-economics +
      • Other topics +
      • Data from papers published in english speaking journals with impact factor
      • Rheumatic conditions
      • ENT conditions
      • Metabolic diseases
      • Heart & vessels
      • Skin diseases
      • Gynaecological disorders
      • Stress related disorders
      • Ageing
      • Other topics
      • A very prevalent condition : in France about 160 000 patients in SPA resorts are treated for KOA
      • Balneotherapy reduces pain and improves functional abilities (RCT)
        • Balint Clin. Rheumatol., 2007, 26 , 890 ;
        • Evcik Joint Bone Spine , 2007, 74 , 60 ;
        • Cantarini, Rheumatol. Int., 2007, 27 , 523 ;
        • Karagülle M, Clin. Rheumatol., 2007, 26 , 2063 ;
        • Vaht, Compl. Ther. Clin. Pract., 2008, 14 , 60 ;
        • Odabasi , J Alt Compl Med , 2008;14:559 ;
        • Sherman , Isr Med Asoc J, 2009;11:88 ;
        • Fioravant i, Am J Phys Med Rehabil. 2010;89:125 ;
        • Fraioli , Rheumatol Int. 2010 Epub
        • Kiliçoglu , Rheumatol Int. 2010;30:739 ;
        • Forestier , Ann Rheum Dis. 2010;69:660 ;
        • Cecarelli , Clin Exp Rheumatol, 2010;28:250
      • Balneotherapy acts on cellular mechanisms
        • Action on pro-inflammatory cytokines damaging cartilage Ceccarelli , Clin Exp Rheumatol. 2010;28:250 :
        • Action on leptine and adiponectin, Fioravanti , Rheumatol Int. 2010; epub
        • Antioxidative, anti-inflammatory, cartilage protection of SULFUR: Benedetti , Clin Biochem, 2010, epub )
        • Potentializes chondroprotective drugs : Caraglia , Exp. Mol. Med., 2005, 37 , 476
        • Action on inflammation markers and anti-oxidative status: Olah , Int J Biometeorol. 2010;54:249
      • Topics made with thermal muds are efficient
        • Mahboob , J Alt Compl Med.2009;11:1239
      • Reviews : Balneotherapy : useful in OA of lower limb
        • Forestier , Joint Bone Spine, 2008;
        • Falagas , Int J Clin Pract, 2009; 63:1068
        • Harzy , Clin Rheumatol. 2009;28:501
      • Meta-analysis : Silver evidence concerning the beneficial effects of mineral baths compared to no treatment; methodological quality of the trials was poor.
        • Verhagen , J. Rheumatol., 2008, 35 , 1118-1123
      • Beneficial on painful chronic spinal conditions
        • Balogh . Forsch. Komplementarmed. Klass. Naturheilkd., 2005, 12 , 196-201 (Low back pain)
        • Olah, Rheumatol Int ., 2008, 28 , 749-756 2008)(low back and neck pain)
        • Kulisch , J Rehab Med.2009;41:73 (low back pain)
        • Beneficial effect on intensity of chronic back pain of balneotherapy and spa therapy .
          • Pittler Rheumatology , 2008, 45, 880 (meta-analysis)
      • Efficiency in Rheumatoid Arthritis
        • Codish, Rheumatol. Int., 2005, 25 , 49
        • Franke, Rheumatol. Int ., 2007, 27 , 703
      • Ankylosing Spondylitis
        • Codish, Isr. Med. Assoc. J. , 2005, 7 , 443
        • Yurkturan, Rheumatol. Int ., 2007, 27 , 703
        • Cozzi, Joint Bone Spine , 2007, 74 , 436
        • and people accept to pay: Boonen, Ann. Rheum. Dis., 2005, 64 , 1650
      • Biological actions
        • H2S reduces IL6 in Fibroblats Like Synoviocytes in RA. Kloesch , Cell Biol Int. 2010;34:477
        • Increase in TGF beta in AS: Shehata, Wien Klin. Wochenschr ., 2006, 118 ,266 )
      • Clinical effects : improvement of pain and function
        • Dönmez, Rheumatol. Int ., 2005, 26 , 168
        • Zijlstra, Rheumatology , 2005 , 44 , 539-546
        • Fioravanti, Rheumatol. Int ., 2007, 27 , 1157
        • for an acceptable cost (Zijlstra, Rheumatology , 2007, 46 , 1454
        • De Andrade , Rheumatol. Int, 2008;29:147
        • Tomas-Carus , J Rehabil Med, 2008;40:248
        • Tomas-Carus , Rheumatology, 2009;48:1147
        • Improvement of respiratory symptoms : Kesiktas, J Back Musculoskelet Rehabil. 2011;24 :57
        • Biological actions : decrease in IL1, LTB4, PGE2 : Ardiç, Rheumatol. Int ., 2007, 27 , 441
        • EVIDENCE
        • * strong Mc Veigh (review), Rheumatol Int, 2008;29:119
        • * moderate Langhorst (meta-analysis) (SMD pain : -1.27 et QOL : -1.16), Rheumatology, 2009;48:1155
        • Recommendations : EULAR B
      • Improvement of sinusal mucoses after surgery (SH, Fe, As water ): reduction of mucoses infiltration by eosinophilic cells (Staffieri, Am J Otolaryngol , 2008;29:223 )
      • Recovery of epithelial cells (junction sites recovery)(NaCl, Br, I water)Fenu , Journal of Alternative and Complementary Medicine, 2010: 341
      • Sulphurous water inhalation is helpful in Upper Air Tract Chronic Infections.Salami , Int J Pediatr Otorhinolaryngol, 2008;72:1717
      • Overweight and obesity reeduction
        • Reduction of 5% of body weight (4kg)(Hanh, 2011, under press )
      • Intestine motility speed increased
        • Gasbarrini, World J. Gastroenterol ., 2006, 12 , 2556
      • Reduction of post-prandial lipaemia, serum and chylomicrons triacylglycerols
        • Schoppen, Br. J. Nutr ., 2005 , 94 , 582
      • Augmentation of insulin sensitivity of post-menopausal women
        • Schoppen, . Nutr. Hosp ., 2007, 22 , 538
      • Improvement of cutaneous trophic lesions of venous insufficiency . Carpentier , J Vasc Surg , 2009;49:163 ).
      • Improvement of gait perimeter in patients with chronic peripheric arterial disease . Fabry , Vasa. 2009;38:213 )
      • CO2 therapy needs better quality assessment. Pagourelias , Int J Biometeorol. 2010; epub
      • Increase in VEGF (NO dependant capillary neo-formation in animal ischemic limb) Irie, Circulation , 2005, 111, 1523
      • Mineral Hydrocolloid gel as efficient and better tolerated than Trolamine in post-radic dermatitis : Ribet, Ann. Dermatol. Venereol., 2008, s1, 5 )
      • Improvement of psoriasis by spa therapy alone
        • Cohen, J. Dermatol. Treat., 2005, 16 , 308
        • Or SPA therapy combined with phototherapy
          • Schiener, Arch. Dermatol ., 2007, 143 , 647-649 ;
          • Brockow, J. Altern. Complement. Med ., 2007, 13 , 725 ;
          • Tabolli , Yonsei Med J.2009;50:215)
      • Silica muds and microalgae (blue Lagoon) improve skin barrier function (expression gene Collagene 1A1 and 1A2) (skin ageing +++). Grether Beck , Experimental Dermatology.2008;17:771 )
      • Efficient in children atopic dermatitis. Farina , J Dermatolog Treat. 2011 Jan 22. Epub
      • Drinking mineral water improves the skin hydratation:
        • Mac Marry, Skin Res. Technol ., 2006, 12 , 199
      • H2S anti-inflammatory action (psoriasis, skin cultures):
        • Polynuclears ( Rinaldi , Lab Invest , 2006;86:391 ) ,
        • Pymphocytes (Mirandola, J Cell Physiol , 2007;213:826 )
      • Action on TNF alpha, IL6, IL8, CK16 expression in psoriasis
        • Chiarini, . Int. J. Mol. Med., 2006, 18 , 1073
        • Dal Pra . Int. J. Mol. Med., 2007, 19 , 373
      • Generalized Anxiety Disorder improvement: Dubois , J Alt Compl Med. 2010;18:1
      • Occupational burnout improved: Blasche , Forsch Komplentmed, 2010;17:132
        • Positive effect on mood and stress :
          • Toda (salivary cromogranin A . Biomed. Res ., 2006, 27 , 11-14
          • Marazziti (increase in platelet serotonin transportation) . Prog. Neuropsychopharmacol. Biol. Psychiatry , 2007, 31, 1436-1439
        • Action on NO system (tetrahydrobiopterin BH4 increased) Pall Medical Hypotheses, 2009;73: 610
        • Corticosteroid secretion reduced
          • Salivary Toda Arch Environ. Occup. Health , 2006, 61 , 131-137
          • Blood Jandova , Endocrine regulations. 2008;42:17
        • DHEA reduced by hot spring immersion .
          • Jandova , Endocrine regulations. 2008;42:17 .
          • Wang , Steroids. 2009;74:945
        • Interest in ageing prevention ( Secher, J Nutr Health Aging. 2009 ;13:797
        • Improvement of QOL of elder people with OA : Gaàl, Isr. Med. Assoc. J., 2008, 10 , 365
        • Even in calcium sufficiency Alkaline Mineral Water lowers BONE RESORPTION. Wynn , Bone,2009;44:120
        • Water exercise program has a positive effect on bone Satus . Rotstein , J Sports Med Phys Fitness, 2008;48:352
      • Bathing is a potential target for disability reduction in the oldest old. Berlau , Am J Public Health. 2011;101:200
        • Antioxidative action : Bender Arch. Med. Res ., 2007, 38 , 86
        • Anti-oxidative properties of SH mineral water drinking Benedetti , Europ J Clin Nutrition. 2009;63:106
      • Water rich in C02 activates parasympathic nerve . Sato , Int J Biometeorol,2009;53:25
        • Sulphurous mineral water decreases GADPH activity ( Albertini , Food Chem Toxicol, 2008;46:3343 )
        • Immune system maintained. Kamioka , J Epidemiol. 2009;19:2219
        • Cutaneous ageing prevention (Blue Lagoon )( Grether-Beck , Experimental Dermatology.2008;17:771 )
      • Reduces the risk of recidive of uratic or oxalo-calcic urolithiasis
        • Karagulle O, . Forsch. Komplement. Med ., 2006, 13 , 9
      • Reduces dyspeptic and irritable bowel syndrome symptoms, increases gastric output and intestine motility speed
        • Gasbarrini, World J. Gastroenterol ., 2006, 12 , 2556
      • Gynaecology
        • Intra-vaginal Dead sea peloid gel increases pelvic blood output and ovarian estrogens and progesterone productionGel : Artymuk , Int J Gynaecol Obstet. 2010 Jan;108(1):72-3.
        • Improvement of chronic uterine inflammation (Fe ++ )( Zamb o, Eur J Obstet Gynecol , 2008;140:252 )
      • Basis : Comparing mineral water and/or muds to tap water or neutral muds
      • Mineral water bathing
        • Improvement remains later in KOA(Balint, Clin Rheumatol, 2007;26:890)
        • And CLBP (Balogh , Forsch Kompl Med, 2005;12:196) ,
        • Acts sooner, more and longer in CLBP patients (Kulisch , J Rehab Med.2009;41:73 )
      • Mineral water bathing or mud applications
        • Better in patients with CLBP (Evcik ,Joint Bone Spine, 2007;74:60)
      • Mineral muds application on KOA
        • Better than washed muds (72% vs 33%)(Flusser, J Clin Rheumatol,2002;8:197 )
        • Better without nylon envelopment (Odabasi , J Alt Compl Med,2008;14:559)
      • Combined spa–exercise therapy besides standard treatment with drugs and weekly group physical therapy is more effective and shows favorable cost-effectiveness and cost-utility ratios compared with standard treatment alone in patients with AS. ASTRID VAN TUBERGEN , Arthritis & Rheumatism, 2002; 47:459
      • Spa therapy leads to a statistically significant reduction in both absenteeism and hospitalization, though it is not clear if these health benefits justify the cost of spa therapy. JONATHAN KLICKA AND THOMAS STRATMANN. Eastern Economic Journal, 2008,epub
      • The military service of the roman republic lasted 30 years
      • Balneotherapy was an essential mean to maintain the roman soldiers on duty
      • Cneius Pompeius (1st century BC) used to organize balneotherapy in the mineral springs of South of France and Spain
      • SPA therapy is a complementary but a scientific medicine
      • With new fields of action to challenge
      • Based on a lot of clinical evidence
        • A significant number of papers (RCT +++) published in journals with impact factor
        • But many RCT have a low statistical power and/or other methodological flaws
      • And many preclinic investigations
      • But so much is necessary
        • To demonstrate the medical benefit of the cares
        • To validate the new fields of action of balneotherapy
      • An international pragmatic cooperation is needed