The Waters

Università degli Studi di Milano
Centro di Ricerche in Bioclimatologia Medica
Biotecnologie – Medicine Naturali
Centro di Ricerche in Talassoterapia
Direttore: Prof. Umberto Solimene
WORLD HEALTH ORGANIZATION
Collaborating Centre
For Traditional Medicine
QUO VADIS,THERMAE?
An old science,for a modern medicine
- UMBERTO SOLIMENE www.naturmed.unimi.it
www.talasso.unimi.it
Brasilia – 14, 15 Maggio 2008
Italian Miniature XV century
THE HISTORY OF THE MEDICINE
•2000 B.C.
Here, eat this root.
•1000 A.D.
This root is heathen.
Here, say this prayer.
•1850 A.D.
That prayer is superstition.
Here, drink this potion.
1940 A.D.
That potion is snake oil.
Here, swallow this pill.
•1985 A.D.
That pill is ineffective.
Here, take this antibiotic.
2000 A.D.
That antibiotic doesn’t work anymore.
Here, eat this root.
THE SPA: AN ANCIENT RESOURCE FOR A MODERN
APPROACH TO HEALTH
SPAS in Italy
Italy has a great many spas, a characteristic it ownes to its
geological conformation. Endowed with more than its fair
share of volcanoes and traversed by a network of
underground waters that are the source of hot and cold
mineral water springs, Italy can be described as a “truly
thermal” country.
Spas have ancient origins and have always been closely
linked to the culture, traditions and customs of Italy: from
the baths and balnea of the ancient Romans that were the
centres of social and recreational life, to the early 20th
century spas for an elite few, and today’s accepted concept of
the spa ,no longer limited to preventive cures and
rehabilitation therapies, as a centre of all-round wellbeing.
Caratteristiche
Modelli di riferimento
prevalenza clientela Salsomaggiore T.
assistita dal SSN
Montecatini T.
scarsa presenza
del ben
Chianciano T.
benessere
Anni
Ottanta
Distanza
atteggiamento stagionalità ricettività
prossimità motivazione
terapeutica
medio
raramente di
raggio
prevenzione
allungata
alberghiera
(aprile - ottobre)
ottobre)
problemi
tendenze
assenza di mercato
arroccamento sulla
concezione sanitaria
nessuna azione di
marketing
tasso di sviluppo
t -2,5%
mancata penetrazione
del benessere
calo clientela
diminuzione delle ricerche
diminuzione
dell'assistenza
Anni
Novanta
forte calo della
clientela
distinzione tra
curandi e curisti
Beauty farm
Saturnia
Ischia
prossimità motivazione
terapeutica
medio
raggio
motivazione
preventiva
allungata
alberghiera
(aprile - ottobre)
ottobre)
Salsomaggiore T.
Montecatini T.
erosione della
domanda
passaggio
al mercato
verso una concezione
di turismo della
salute che non
riesce ad imporsi
t -6-7%
"regionalizzazione"
regionalizzazione" della
proprietà delle terme più
pubbliche più significative
Chianciano T.
passaggio ad una Centri
concezione di terza talassoterapici
francesi
generazione
Ischia
Anni non solo cura e
Duemila prevenzione ma
I Parchi o le aree
anche promozione ambientali e della
salute
del proprio stato
di salute
MEDICINA TERMALE INTEGRATA
prossimità motivazione allungata
alberghiera
preventiva
(aprile - ottobre)
ottobre)
nuove forme
medio
motivazione di
(agriturismo raggio
promozione della
villaggio
salute
termale
lungo
etc.)
raggio
integrazione tra terme logica del
e benessere
parco ambientale
della salute
"privatizzazione"
privatizzazione" della
gestione delle aziende riposizionamento
pubbliche
delle "città termali"
termali"
unicità di comportamento tra
le Regioni
Il sistema termale europeo
t. +3%
IL SETTORE
Le Terme in Italia (dati 2007)
Aziende termali
⇒
350
Addetti diretti
⇒
15 mila
Addetti compresi l’indotto
⇒
70 mila
Fatturato termale
Di cui a carico del Ssn
Fatturato Indotto
⇒
⇒
⇒
350 milioni euro
100 milioni euro
Circa 4 miliardi
Curandi a carico del Ssn
⇒
1,3 milioni
Curandi totali
⇒
Circa 2 milioni
Presenze termali
⇒
30 milioni
Turismo
2,8 milioni di arrivi
italiani 5,3
complessivo nelle
città termali
14,4 miloni di presenze
L.It
Euro
Giro di affari
complessivo
567 miliardi
293 milioni
delle aziende termali
Economia dell'indotto
Occupati
3.800 miliardi
14,5 mila
Permanenza media
stranieri 4,6
nelle
complessivo 5,0
città termali
Euro
L.It
98 milioni
189 miliardi
a carico enti assistenziali
91 milioni
176 miliardi
a carico curandi
99 milioni
192 miliardi
non da core business
1.962 milioni
12,5 mila
2 mila
dipendenti fissi e stagionali
collaboratori
Spa treatments have to be
prescribed according to precise
clinical rules, at stage of the illness
when they can be effective; the
precise duration of treatments
cannot be fixed in advance as the
appropriate length of treatment
varies according to the individual
clinical profile.
Incidenza delle patologie curate dalle terme italiane
Posizionamento
Patologia curata
Inc. %
Posizionamento
Patologia curata
Inc. %
1
Naso e Gola
29,4
6
Altre
2,0
2
Artroreumatiche
29,0
7
Vascolari
periferiche
1,9
3
Apparato
digerente
22,2
8
Dermatologiche
0,6
4
Broncopolmonari
9,0
9
Ginecologiche
0,5
5
Orecchio/tuba
5,3
10
Apparato urinario
0,1
Distribuzione per sesso delle diverse componenti della clientela
delle aziende termali italiane
Uomini
Donne
ASL
44,3
55,7
INPS
50,2
49,8
INAIL
73,4
26,6
Convenzionati
44,7
55,3
Privati termali
39,8
60,2
Termali classici
44,4
55,6
Benessere termale Med. Term. Int
15,8
84,2
Clientela complessiva
42,3
57,7
Incidenza delle componenti della clientela
delle Aziende Termali in Italia - 2006
7,4%
20,5%
72,1%
Convenzionati
Privati termali
Benessere termale
From the NAIADE survey in Italy (2000 – 2004)
HOW TO CHOOSE A SPA
•
•
•
•
•
•
•
•
•
•
“ The Waters ”
Food, Nourishment, Diet and Nutrition
Movement, Exercise and Fitness
Touch, Massage and Bodywork
Mind/Body/Spirit
Aesthetics, Skin Care, Natural Beauty Agents
Physical Space, Climatology, Global Ecology
Social/Cultural Arts and Values, Spa Culture
Management, Marketing and Operations
Time, Rhythm and Cycles
SPA THERAPIES
· RHEUMATIC DISEASE
· EAR, NOSE AND THROAT AILMENTS
· GASTROENTERIC DISORDERS
· DISORDESR OF THE RESPIRATORY TRACT
· DERMATOLOGICAL DISORDERS
· VASCULAR DISORDERS
· DISORDERS OF THE URINARY TRACT
· GYNAECOLOGICAL DISORDERS
· SPA REHABILITATION
· THE SOURSE OF WELL-BEING
TERMOTERAPIA TERMALE
⇒ Azione analgesica
⇒ Azione miorilassante
⇓
Per innalzamento soglia del dolore e
ridotta sensibilità allo stiramento dei
fusi neuromuscolari.
Principali indicazioni all’ idrokinesiterapia termale
Neurologia
Traumatologia
• Paralisi periferiche
• Fratture
(poliomielite, neurite, poliradicoloneurite)
• Strappi, distrazioni muscolari,
• Patologie del sistema nervoso centrale
distorsioni, lesioni tendinee
(paraplegie, emiplegie, tetraplegie
• Rieducazione del politraumatizzato
incomplete, postumi di traumi cranici)
Reumatologia
• Polisclerosi (non in fase evolutiva)
• Miopatie
• Patologie articolari degenerative
(artrosi)
• Patologie articolari infiammatorie
Ortopedia
(in fase non acuta)
• Paramorfismi e dismorfismi dell’età
• Lombalgie, cervicalgie, lombosciatalgie,
evolutiva (scoliosi, cifosi, epifisiolisi)
cervicobrachialgie (in fase sub acuta e
• Postumi d’interventi chirurgici che
cronica)
necessitano mobilizzazione in scarico
• Periartriti, fibrositi
(in fase sub acuta e cronica)
• Rigidità muscolari, ipotono-ipotrofie
muscolari
SPA THERAPIES
A. Thermal Mud Therapy
This medically recognized therapy
involves using thermal mud. Which
has a viscous quality and may be
either naturally hot or heated. It is a
blend of solid inorganic and/or
organic components mixed with
mineral water.
B. Balneotherapy
Balneoherapy consists of the complete or partial immersion of
the patient in an individual bath or a “collective” pool
containing mineral water that has been brought to and
maintained at the recommended treatment temperature.
Balneotherapy in an individual bath consists of full or partial
immersion in a bath specially adapted for physiotherapy and
rehabilitation. Bathing in thermal pool is also suitable for
active and passive physiotherapy and kinesotherapy.
The key factors in balneotherapy are :the temperature of the
water; the prescribed duration of the bath; and the length of
the treatment cycle – on ave – rage one bath a day for 10-20
days. Finally, the bath should be taken on an empty stomach.
PRINCIPALI REAZIONI ALLA FANGO-BALNEOTERAPIA
1. Termoassorbimento 1.1 Aumento temper.
temper. interna
da 0,30 a 1°C e più
2.1 Stimolazione processi termoregolatori:
• per impulsi afferenti dai termoricettori
• per azioni dirette della temperatura del sangue
A. Reaz. dovute
prev. al calore
2. Termodispersione
2.2 Stimolazioni sanguigne e linfatiche:
• iperemia cutanea con aumento velocità
di circolo (effetto termosifone)
2.3 Sudorazione
2.4 Stimolazione metabolismo idricoidrico-salino:
• richiamo di liquidi nel torrente circolatorio
(lavaggio tessutale)
3. Sollecitazioni scambi metabolici
4. Riduzione ipertono muscolomuscolo-tendineo
B. reaz. dovute
alle tre componenti
associate
• sollecitazione archi riflessi
• azioni sul S.R.E. e I.
• azioni sulla capacità adattativa
• azioni sul connettivo
EFFETTI CURATIVI DELLA FANGO-BALNEO TERAPIA
Azione emodinamica
Aumento del flusso sanguigno e del numero
dei capillari funzionanti (capillarizzazione)
1. Sulla nutrizione
Azione metabolica
Aggiustamento reaz. chimiche intra ed
extracellulari: modificazioni delle attività
enzimatiche, del potenziale di membrana,
dell’equilibrio idrico salino, ecc.
Azione detossicante
Drenaggio sostanze cataboliche:
Lavaggio tessutale, ecc.
EFFETTI CURATIVI DELLA FANGO-BALNEO TERAPIA
Adeguamenti funzionali a diversi livelli:
Cellule, tessuti, organi, con migliorata reattivit
vasculo-tessutale alle noxe patogene
2. Sulla capacità
adattativa
Azioni sulla cenestesi
Sensazione di benessere per migliore
adattamento alle variazioni del mezzo
interno ed esterno
Riequilibrio nervoso
Per azioni neuro-umorali, eutrofiche, ecc.:
migliore integrazione tra gli elementi
cerebrospinali e neuro-vegetativi
EFFETTI CURATIVI DELLA FANGO-BALNEO TERAPIA
5. Sulle alterazioni
del connettivo
6. Sul metabolismo
dell’osso
Azioni sul metabolismo connettivale
Miglioramento processi fibrositici
pericapsulari e legamentosi, rigidità
muscolo-tendinee, processi di riassorbimento
degli essudati
Azioni generali e locali
Sul trofismo osseo
OSTEOPOROSIS
Spa therapies may involve:
- The assimilation of calcium in
mineral water without the
accompanying contribution of
calories that occurs when taken in
the form of food.
- External thermal cures
(balneotherapy, mud baths), which
can alleviate the symptoms of the
disease.
C. Antrotherapy
Antrotherapy means literally cave
therapy (antrum=cave). The caves, which
may be naturally occurring or artificially
created, are situated around very hot
mineral springs. There are two kinds of
cave: “humid” where the stream from
hot springs circulates in the cave, and
“dry” where only the heat is transmitted.
The latter is also know as a stufa or oven.
Rheumatic diseases for which SPA
therapies are indicated
· Primary and secondary arthrosis
· Extra-articular rheumatism: fibre
myalgia
· Dysmetabolic rheumatism: gout
and pseudogout
Ear, nose and throat ailments for which
SPA therapies are indicated:
- Chronic inflammation of the upper respiratory
tract, in particular rhinitis and rhinosinusitis
- Allergic rhinitis
- Nonspecific vaso-motorial rhinopathy
- Atrophic rhinopathy
- Chronic rhino-otitis
- Secretory otitis of the middle ear
- Tubal disorders
- Rhinogenic deafness
- Chronic forms of pharyngo-tonsilitis
- Chronic adenoiditis
- Chronic laryngitis
Disorders of the respiratory tract for
which SPA therapies are indicated:
- Acute and chronic tracheobronchitis
- Chronic simple bronchitis or
accompanied by obstruction
- Allergic pathologies of the laryngotracheo-bronchial apparatus
SPA THERAPIES
The various inhalation methods allow mineral water or
its gases to be introduced to the ear, nose and throat as
required. The principal methods are:
A. Nebulizations
Mineral water transformed into a mist of variable
density is released into a room where the patients
remain for the duration of the treatment. Patients can
also be treated with individual nebulizers.
B. Inhalation
The mineral water is broken down into droplets of
varying size.
C. Aerosol
Special aerosol equipment delivers the mineral water
in microscopic droplets, the diameter of which is
between 3 and 10 microns.
D. Humages
This method uses mineral water gas.
E. Nasal irrigation and micronized nasal douches
Temperate thermal water is allowed to flow
continuously into the nasal cavities for a period of time
that varies according to the individual patient’s needs.
D. Nebulization
Mineral water transformed into a mist is
released into a room where the patients
remain for the duration of the treatment.
Patients can also be treated with individual
nebulizers.
E. Pulmonary ventilation
This method uses special equipment to
apply intermittent positive/negative
pressure.
D. Mineral Water Cure
This cure consists of drinking mineral
water at fixed intervals, the quality
temperature, duration and timing of which
is also strictly controlled.
E. Treatments combined with
crenotherapy
Spa therapies can successfully be combined
with the many methods of rehabilitation.
Mineral Water Cure
This cure consist of drinking a precise quality of one or more
mineral water, the timing, frequency and temperature of which
is prescribed by the spa’s doctor.
The volume of water and solutes is usually greater than that
needed by the body’s normal homeostatic mechanisms.
The following must be taken into consideration:
- The quality of mineral water or waters
- Time of year
- At what time the cure is started
- The temperature of the water
- The amount of water consumed with each drink
- How slowly it should be drunk and the interval between each
drink
- Other procedures to be observed during the cure
- The position to adopt during the cure
Gastroenteric disorders for which
SPA therapies are indicated:
- Gastric dyspepsia
- Bilious dyspepsia
- Bilious dyskinesia
- Chronic simple constipation
Water, mud and balneotherapy
This treatment consist of applying a mud
pack around the area of the liver; it is then
followed by bathing in mineral water
Rectal douche
In this treatment a rigid or semi-rigid
cannula is used to introduce mineral water
under pressure at regular intervals into
the rectal ampulla
Dermatological disorders for which
SPA therapies are indicated:
- Psoriasis
- Eczema and atopic dermatitis
- Recurrent seborrheic dermatitis
- Angiopathic dermatosis
- Pruriginous dermatosis
- Acne
- Burn treatments
SPA THERAPIES
Mineral water is used for external applications:
A. Balneotherapy
Balneotherapy consist of the complete or partial
immersion of the patient in a bath or a pool
containing mineral water, the recommended
temperature of which may vary as does the duration
of the bath.
B. Thermal mud therapy
This therapy involves using thermal mud, which has a
viscous quality and may be naturally hot or it may be
heated. It is a blend of solid inorganic and/or organic
components mixed with mineral water.
Vascular disorders for which SPA therapies
are indicated:
- Primitive viscose veins
- Secondary varicose veins and
postthrombophlebitic syndrome
- Early venous insufficiency caused by
“venous pump” dysfunction
- Lymphoedemas (low grade)
- Angiophatic dermatosis (angiodermitis,
dry eczemas, hypodermitis, dystrophic
ulcers)
SPA THERAPIES
In this case the treatment consist of balneotherapy combined
with hydromassage and “vascular exercise”.
Balneotherapy consist of the complete or partial immersion of
the patient in a bath or a pool containing hot mineral water, in
keeping with the general principles of balneotherapy.
The vascular exercise
This involves walking up and down two pools al least 80 cm
deep. They have a special floor that is beneficial to the vascular
system, and there is a temperature difference of 5-10° C
between two pools. The exercise should last 20 minutes during
which time the patient also receives the beneficial effects of jets
of water and ozone situated at various heights along the length
of the pool.
Disorders of the urinary tract
for which SPA therapies are
indicated:
- Calculosis of the urinary tract
and recurrences
- Urinary tract infections
SPA THERAPIES
Mineral water cure
This cure consist of drinking mineral water at set times, the
quality, temperature, timetable and frequency also being
determined in advance. Other factors that have to be taken
into consideration are:
- The quality of mineral water
- The time of year
- The time when the cure is started
- The temperature of the water
- The quality of the single draught and the total quantity of
mineral water to be drunk in a day
- Haw long each drink lasts and the time lapse between each
drink
- Procedures to be adhered to during the cure.
Gynaecological disorders for which
SPA therapies are indicated:
- Chronic aspecific and dystrophic
vaginitis caused by persistent
leucorrhea
- Painful sclerosis of pelvic
connective tissue due to scarring or
involutional changes.
SPA THERAPIES
The therapy in this case is vaginal irrigation that may or
may not be combined with thermal bath.
Vaginal irrigation
Mineral water at 37°C is allowed to flow into vagina
through an irrigation per day for 12-15 days.
Balneotherapy
Balneotherapy consist of complete or partial immersion
of the patient in a bath or a pool containing mineral
water; the length of time spent in the bath and the
temperature of the water varying according to the
patient’s history.
SPA REHABILITATION
The following spa resources all have a role in the
rehabilitation of the locomotory, neurological,
respiratory and cardiovascular apparati:
- Mineral waters and all their applications
- Thermal mud
- Caves and stufe
- Other therapeutic treatments and/or courses
(corrective gymnastics, active and passive exercise,
courses of physical therapy) and the opportunity to
alternate or combine them
- Health and medical services
- Ecologically and climatically pleasant surroundings
SPA THERAPIES
· RHEUMATIC DISEASE
· EAR, NOSE AND THROAT AILMENTS
· GASTROENTERIC DISORDERS
· DISORDESR OF THE RESPIRATORY TRACT
· DERMATOLOGICAL DISORDERS
· VASCULAR DISORDERS
· DISORDERS OF THE URINARY TRACT
· GYNAECOLOGICAL DISORDERS
· SPA REHABILITATION
· THE SOURSE OF WELL-BEING
The source of well-being
Spa resources can be used in many different ways but
the approach, as in cosmetic medicine, has to be
scientific. Seasoned mud yields its cosmetic potential to
rehydrate the skin through the interaction of water and
other components in the mud with active substances in
the skin; it acts as a vehicle for pharmacologically
active molecules in the mud that have beneficial effects
on our health and well-being.
Staff are always guided in their choice of treatment by
the patient’s individual requirements and the potential
benefits of the treatments. They are often combined
with special diets and preventive gymnastic.
Safeguarding our health
The therapeutic efficacy of spa therapies and their case
of use are such that they can have a marked positive
impact on our health in terms of prevention as well as in
the realms of therapy and rehabilitation.
In the many areas of Italy where mineral springs occur,
spas exploit the waters, muds and caves to provide
totally natural cures for preventive, therapeutic and
rehabilitative purposes.
In order to meet the demands and expectations of
international tourism, Italian spas have shifted their
focus to health protection rather than curing disorders,
finding in thermal medicine an answer both to
prevention and the recovery of psychological and
physical wellbeing.
THE WHO REPORT ABOUT STATE OF HEALTH
IN THE WORLD (2006)
10 main factors of risk about health in the world
- Deficiency in weight and malnutrition
- Not protected sexual relations
- Hypertension
- Tobacco
- Alcohol
- Not drinking water and bad sanitary meausures
- Hypercholesteremia
- Smoke and indoor pollution
- Deficiency in iron
- Obesity
TARGET 11 – HEALTH21
By the year 2015, people across society should
have adopted healthier patterns of living.
In particular:
⇒ 11.1 healthier behaviour in such fields as
nutrition, phisical activity and sexuality
should be substantially increased.
⇒ 11.2 there should be a substantial increase in
the availability, affordability and
accessibility of safe and healthy food
I WANT TO SHARE MY VISION
I want to share my vision of where I expect complementary and
alternative medicine to be in the years to come. As a result of rigorous
scientific investigations, several therapeutic and preventive modalities
currently deemed elements of CAM will prove effective. Therefore, in
future years, these interventions will be integrated into conventional
medical education and practice, and the term “complementary and
alternative medicine” will be superseded by the concept of “integrative
medicine”. The field of integrative medicine will be seen as providing novel
insights and tools for human health, and not as a source of tension that
insinuates itself between and among practitioners of the healing arts and
their patients.
Stephen E. Straus, M.D.
Director National Centre for Complementary & Alternative Medicine
National Health Institutes
DEFINITION OF TRM/CAM
Definition of Complementary/Alternative Medicine
(CAM)
“Complementary /Alternative / Non-conventional
Medicine” are used inter-changeably with Traditional
Medicine in some countries. It refers to a broad set of
health care practices that are not part of the country’s
own tradition and are not integrated into the dominant
health care system.
WHO General Guidelines for Methodologies on
Research and Evaluation of Traditional Medicine
DEFINITION OF TRM/CAM
Definition of Traditional Medicine (TRM)
Traditional Medicine has a long history. Traditional Medicine
is the sum total of knowledge, skills and practices based on the
theories, beliefs and experiences indigenous to different
cultures, whether explicable or not, used in the maintenance of
health, as well as in the prevention, diagnosis, improvement or
treatment of physical and mental illnesses. The terms
complementary / alternative /non-conventional medicine are
used inter-changeably with Traditional Medicine in some
Countries.
WHO General Guidelines for Methodologies on
Research and Evaluation of Traditional Medicine
FEMTEC Nongovernmental Organization acknowledged by WHO
THE 61 –st GENERAL ASSEMBLY AND
INTERNATIONAL SCIENTIFIC CONGRESS
OF THE WORLD FEDERATION OF HYDROTHERAPY
AND CLIMATOTHERAPY
(FEMTEC)
EAST & WEST MEET
“WATER & CLIMATE FOR HEALT IN THE MODERN SOCIETY”
25th - 29th November 2008
Ocean Spring Hotel
Zhuhai, CHINA
FEMTEC - AEMB - AICEB
THERMAE CAMPUS®
&
THERMAE QUALITY
International Superior School of Training and Updating on Science of
“Thermae”, Medical Ecology and Life Styles)
“VIRTUAL” CENTRE OF TRAINING AND
THEORETICAL AND PRACTICAL ADVICE
1) SCIENCE OF “THERMAE” (from Thermal Centres
to SPA):
• Integration between scientific medicine and traditional medical
learning
•Non medical/thermal operators and wellness
• Medical and administrative management and marketing
• Communication of Sanitary - Tourism Arts
• Plant engineering and architectural techniques
2) MEDICAL ECOLOGY
• Geology, environment-climate, health
3) LIFE STYLES
•
•
•
•
Nutrition
Relation mind/body
Physical activity
Hydrology and traditional complementary
techniques
• Healthy Ageing
EXPERT TEACHERS OF:
- WHO
- Harvard Medical School
- State University of Milan
- Cegos Italia
- France, Germany, Russia, Switzerland,
Hungary
Courses are accredited by Regions
and Ministry of Health
Thank you
and
welcome
to Milan!