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In our previous study setting, climatotherapy programme consisted of six sessions - four in the mid-mountain area and two in a flat park. For all sessions, the subjects underwent climatotherapy in the morning under slightly cool conditions. During each session, the subjects' blood pressure, pulse rate, skin temperature, blood lactate, salivary cortisol and mood profile were recorded, and meteorological data were collected at the sites. We hypothesised that exercise habits, changes in mood profile and effective temperatures during the session, and physical exertion during the climatic terrain cure would affect salivary cortisol levels. Subjects were 30 (spring) and 29 (autumn). Multiple linear regression analyses were performed to examine the determinants of the change in salivary cortisol levels. In the mountain setting, salivary cortisol was elevated, even though the sessions took place in the descending phase of the circadian salivary cortisol variation; however, the post-session cortisol increase was not significant. Increased post-session salivary cortisol was significantly associated with female gender, older age, higher BMI, lower body fat, less daily physical activity, increased blood lactate, increased 'Tension-Anxiety' and 'Depression-Dejection' moods, and decreased 'Anger-Hostility' mood. The increase in cortisol may have been due to older age, a predominance of females, and the increased blood lactate due to the mountainous terrain. In the flat park, the significant decrease in postsession salivary cortisol was related to the descending circadian phase of circadian cortisol variation and the low physical demands of the sessions.

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An accelerated climatotherapy programme was evaluated for use with busy people in mid-mountain and flat lowland areas. A total of 43 urban residents participated in this climatotherapy programme. Participants' blood pressure, pulse rate, peripheral skin temperature and levels of salivary amylase, salivary cortisol and blood lactate were measured, and they completed the Profile of Mood Status questionnaire. In the mid-mountain area, which had a cooler environment and long uphill paths, participants' percentage of maximum pulse rate (70.01%) to estimated maximum heart rate was higher than that (59.67%) of participants in the flat lowland area, suggesting that the mid-mountain area was suitable for endurance training. At both sites, the decrease in peripheral skin temperature during the climatic terrain cure suggested that our programme was properly implemented with a cool body surface in accordance with our purpose. Negative moods improved quickly, suggesting that the forest environment and the fresh-air rest cure may have relaxed participants. In late spring and early autumn, the mood of approximately 25% of participants improved to an Iceberg profile, which is associated with positive mental states and athletic peak performance, after climatotherapy. On the other hand, the weather in early spring and late autumn was more likely to facilitate maintenance of a cool body surface during the climatic terrain cure. With the support of individualized feedback provided after the climatotherapy sessions, three participants developed regular exercise habits, serving as a good example of the effectiveness of our climatotherapy programme to elicit behavioural change.

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BACKGROUND: The minimum clinically important difference (MCID) for the St George's Respiratory Questionnaire (SGRQ) is debated in chronic obstructive pulmonary disease (COPD) quality-of-life (QoL) assessments. This study aimed to determine whether there is a difference in predictors of clinically significant improvement between the traditional (value of 4) and newly proposed MCID SGRQ (value of 7) after climatic rehabilitation treatment. Climatic rehabilitation treatment consists of two main parts: climatotherapy, which typically involves the controlled exposure of individuals to natural environmental elements, and climatic rehabilitation, which includes other therapeutic factors such as physical activities as well as educating the patient to change their lifestyle. METHODS: This study included 90 consecutive patients diagnosed with COPD who underwent structured complex pulmonary rehabilitation in High Tatras, part of the Carpathian Mountains. The examination before and after treatment included spirometry, QoL assessment using the SGRQ, 6 min walk test (6-MWT), and the Borg, Beck and Zung scale. RESULTS: Patients showed statistically significant improvement after the intervention in FEV1, FEV1/FVC, 6-MWT, (p < 0.001), anxiety scores, depression, and improvement in dyspnoea both before and after the 6-MWT (p < 0.001). For both MCID for SGRQ levels 4 and 7, we confirmed the same predictors of clinical improvement for bronchial obstruction grade (spirometry) and exercise capacity (6-MWT), for quality of life in activity score and total score. CONCLUSION: The results suggest that both the proposed MCID for SGRQ values could be sufficient to assess the clinical significance of the achieved change in health status when assessing the need for pulmonary rehabilitation comprising climatotherapy in patients with COPD.

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Asthma affects over 300 million people globally and is a cause of substantial burden of disease, including both premature death and reduced quality of life in people of all ages. Although both genetic and environmental factors play an important role in the pathogenesis of asthma, the rising trend of asthma and other allergic diseases over recent decades is thought to be largely caused by alteration in environmental conditions. Thus, a considerable amount of attention has been paid to environmental modification for the treatment and management of asthma, including household allergen reduction and/or irritant removal. More advanced environmental modification strategies (e.g., health resort medical rehabilitation, high-altitude climate therapy and multiple-hit interventions) have also been suggested. Research advances have been made over the past decades, but major challenges and opportunities coexist in this emerging field. Concerted efforts are required to tackle these formidable challenges.

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BACKGROUND: Positive influence of the sun on psoriasis is a common assumption in dermatology. Other season-related factors such as mental health may interfere. However, the role of seasonal effects on psoriasis needs to be clarified. This review aims to systematically analyze the literature on seasonal variation on psoriasis with emphasis on Northern and Central Europe representing temperate climate conditions. MATERIALS AND METHODS: Enrolled literature was identified through PubMed, EMBASE, and BIOSIS. An additional manual search of old reports before the introduction of efficient modern therapies, which can interfere with the spontaneous disease, was performed. RESULTS: Thirteen studies were enrolled. About 50% of psoriasis patients were stable and showed no seasonal difference between seasons. Approximately 30% improved in summer, and 20% performed better in winter, some with marked summer worsening. European results matched international reports from different continents and hemispheres with climate extremes. The psychological effects could not be ruled out. CONCLUSION: About 50% of psoriasis patients experience a season-independent disease, however, with a subset of patients who do better in summer. Others again do better in winter, with a few of these having marked worsening in warm periods. Individual season-related activity records should be paid proper attention to when considering light therapy or climatotherapy as a treatment.

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OBJECTIVE: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. METHODS: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. RESULTS: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. DISCUSSION AND CONCLUSIONS: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.

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OBJECTIVE: Scientometrical analysis of studies the use of climatotherapy methods and formulation of guidelines based on the evidence obtained during the analysis. MATERIAL AND METHODS: The article presents the data of scientometrical analysis of 40 publications on the use of climatotherapy in spa practice. RESULTS: Clinical effects and proposed mechanisms of action of the proven efficacy climatotherapy methods - aerotherapy, heliotherapy and thalassotherapy for the patients with various chronic diseases are presented. The clinical directions for the using of climatotherapy methods in climatic resorts are highlighted. CONCLUSIONS: Regular generalization and analysis of existing evidence-based studies is required, as well as the implementation of new high-quality randomized controlled clinical trials to study the effects of climate therapy on a wide range of patients with common socially significant diseases.

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Background: Dead Sea climatotherapy (DSC) is a treatment option for psoriasis in Denmark. However, the response to DSC has not been particularly well studied. Aim: We sought to determine effectiveness and response duration of DSC on psoriasis-related outcome parameters. Methods: Eighteen patients participated in a 4-week treatment program in Ein Gedi in Israel. Treatment, consisting of sun exposure and bathing, was individualized. Results: DSC was associated with a mean 13.0-point reduction (88%) in Psoriasis Area and Severity Index and a mean reduction of 2.3 (76.7%) on the 5-point Investigator's Global Assessment Scale. Furthermore, patients' quality of life improved measured by the Dermatology Quality of Life Index and EuroQol 5D index values. The mean time from treatment end to reappearance of visible skin symptoms was 93.8 days (SD: 62.5, range: 31-219 days). Conclusions: Our results confirm that DSC has an immediate effect on skin manifestations and improves quality of life, but long-term disease control is not observed.

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The aim of this study was to compare long-term results of 4 weeks Dead Sea climatotherapy at the Deutsches Medizinisches Zentrum, Israel to those obtained by classical topical treatment for moderate-to-severe atopic dermatitis. Seventy-two children from the Czech Republic were divided into three groups of 24 and treated during three periods (March 2014, October 2014 and March 2015) with gradually increasing sun exposure during 28 consecutive days. Forty-four children were treated with steroid creams at the Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic. The primary outcome was the change in the SCORing Atopic Dermatitis (SCORAD) index, recorded after 1 month of treatment (immediately after DSC) and 3, 6, 9, 12, and 18 months later in Prague. The mean SCORAD improvement was 87.5 ± 13.4% after 4 weeks at the Dead Sea and 86.1 ± 11.3% after 1 month of treatment with steroid creams in the Czech Republic. All 44 patients treated in Prague participated in this 18-month follow-up study, whereas only 47 patients (65.3%) after DSC treatment. Good clinical results were maintained in both groups and mean SCORAD values were stable and low, around 5.

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Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.

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Asthma is a serious public health challenge for all age groups around the world. Heightened attention surrounds the use of the natural therapeutic factors that potentially make medication more cost-efficient in the treatment of diseases. Our research has tried to reveal how the medical conditions, quality of life of asthmatic patients change after medical treatments that are accompanied by climate therapy. Asthma patients (514 patients) participated in a 3-week complex therapy at Mátra Health Resort. Beyond medical examinations and treatments, patients were involved in breathing exercises on the curing terraces or outdoors twice a day, they were to attend the rehabilitative physical exercises led by a physiotherapist once a day, were given dietetic and lifestyle advice and provided with diets that were fitted to their individual medical conditions. Their respiratory function was examined before the commencement of the cure as well as after the therapy just before departing from the institution. The patients' exercise capacities were assessed with the 6-minute walk test before the treatment and then 3 weeks later. For the patients, a questionnaire was compiled to reveal information in relation to their conditions in the first 6 months after leaving the institution. Our results show that values of respiratory function in the sample and 6-minute walk test significantly improved with the treatment. After leaving the institute, the results of the Asthma Control Test in the 1st month after treatment revealed a significantly better quality of life and better control-level of patients than after the 3rd month. Orv Hetil. 2018; 159(27): 1103-1112.

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Vitiligo is an acquired chronic hypopigmentary disorder, which usually stars in childhood. The Authors discuss a short review of the more innovative therapies for childhood vitiligo.

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Twenty-nine urban inhabitants participated in a half-day climatotherapy programme at the moderate mountain area and lowland area in the northwest part of the main island of Japan. The current study was aimed to investigate physically and mentally the objective and subjective influence of our short programme, which was a prospective pilot study of single intervention. Blood pressure was significantly descended during terrain cure at the uphill mountain path and returned after fresh-air rest cure, while there was no significant change throughout the programme at lowland flat path. Heart rate was significantly ascended and descended at both area, and more clearly changed at the mountain path. Profile of Mood Status brief form Japanese version administered before and after our half-day programme. Age adjusted T score of negative subscales, 'tension-anxiety', 'depression', 'anger-hostility', 'fatigue' and 'confusion' were significantly lower after climatotherapy at both sites. Whereas, there was no significant change concerning 'vigour' score. This short-version climatotherapy programme has been designed for people without enough time for long stay at health resort. It turned out our half-day climatotherapy programme contribute to mood status improvement. In addition, repeated practice of our short-version programme including endurance exercise with cool body shell using uphill path can be expected that blood pressure will go toward the normal range and heart rate will decrease both in usual time and during exercise. Therefore, health benefits can be expected of this climatotherapy programme.

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BACKGROUND: Atopic dermatitis (AD) is a common, chronic, and relapsing inflammatory skin disorder. Moderate to severe cases represent an extremely disabling disease, for both children and their parents. Dead Sea climatotherapy (DSC), recognized as a natural treatment for patients with skin diseases, takes advantage of the selectively scattered ultraviolet irradiation (UV) present at the lowest terrestrial site on the earth. OBJECTIVES: To investigate the impact on short-term results of DSC in moderate to severe AD children from the Czech Republic treated 4 weeks at the Deutsches Medizinisches Zentrum (DMZ), Israel, and to correlate their results to the cumulative UVA and UVB irradiation doses received during treatment. PATIENTS AND METHODS: Seventy-two patients aged <19 years were divided into three groups and treated in March 2014, October 2014, and March 2015 with gradually increasing sun exposure during 28 consecutive days. Daily and cumulative exposure doses of UVB and UVA were calculated through patients' recorded sun exposure logs. The SCORing Atopic Dermatitis (SCORAD) index was recorded immediately after DSC and 3 months later by the same dermatologist. RESULTS: Good clinical results were observed in all groups, with overall improvement in SCORAD reaching 87.5 ± 13.4% and 71.3 ± 21.3% immediately after DSC and 3 months later, respectively. No side effects were observed during the treatments. Higher cumulative exposure times correlated with better results and enhanced remission. CONCLUSION: Dead Sea climatotherapy represents a valuable option for the treatment of AD in children. Medically controlled and prescribed sun exposure seems to directly and positively influence the results obtained.

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Scaling up and replication of successful innovative integrated care models for chronic diseases is one of the targets of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). MACVIA-LR® (MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon) is a Reference Site of the EIP on AHA. The main objective of MACVIA-LR® is to develop innovative solutions in order to (1) improve the care of patients affected by chronic diseases, (2) reduce avoidable hospitalization and (3) scale up the innovation to regions of Europe. The MACVIA-LR® project also aims to assess all possible aspects of medicine-including non-pharmacologic approaches-in order to maintain health and prevent chronic diseases. These approaches include hydrotherapy and balneotherapy which can be of great importance if health promotion strategies are considered. Balneotherapy at Balaruc-les-Bains focusses on musculoskeletal diseases and chronic venous insufficiency of the lower limbs. Each year, over 46,000 people attend an 18-day course related to a new falls prevention initiative combining balneotherapy and education. On arrival, each person receives a flyer providing information on the risk of fall and, depending on this risk, a course is proposed combining education and physical activity. A pilot study assesses the impact of the course 6 and 12 months later. This health promotion strategy for active and healthy ageing follows the FEMTEC (World Federation of Hydrotherapy and Climatotherapy) concept.

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  We used the data published recently by a team headed by the late Professor Shaul Sukenik, in order to shed light on the huge amount of work realized by this exceptional physician, who devoted his life to his family, his profession and the Dead Sea.   Particularly, he wanted very early - and always succeeded - to apply the strictest rules of clinical studies in the fields of Balneotherapy and Spa treatment, thus lifting them up to their highest level of credibility. Thanks to his works, one can stipulate with authority that Dead Sea treatments are beneficial in several rheumatologic disease and have a good safety profile.   The Dead Sea, the deepest and most saline lake on earth, has been known from biblical times for its healing properties. The systematic review presented critically the level of evidence for the claims of therapeutic effects of Dead Sea treatments in several rheumatologic, skin and lung diseases and, as well, reviewed these treatments’ safety.   The authors found bona fide evidence that Dead Sea treatments are especially effective in psoriasis due to both special characteristics of solar ultraviolet radiation and Dead Sea water balneotherapy. Dead Sea mud and balneotherapy have been found to be beneficial in rheumatologic diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and knee osteoarthritis.   In the safety analysis, no evidence was found for an increase in skin neoplasia, although skin actinic damage seems to be amplified in patients treated in the Dead Sea. Dead Sea treatments do not lead to worsening of high blood pressure. Substantial ingestion of Dead Sea water (generally in unusual near-drowning cases) is toxic and can result in cardiac rhythm disturbances because of electrolyte concentration abnormalities. Finally, laboratory analysis of Dead Sea mud did not reveal mineral concentrations that could represent a health concern for their intended use.

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Objective: To review the related articles and consider the potential of Japanese climate and geographical features to health promotion and disease prevention in the context of health resort medicine. Method: To summarise the studies concerning climatotherapy in the world, PubMed database was searched from 1965 to 2014. Additional references were identified from bibliographical searches of included studies. Results: One hundred thirty-five articles were included. These articles were sorted according to the place of health resort and the objective: 1) At the Dead Sea, of maritime climate with natural sunlight and salt water, climatotherapy for psoriasis, atopic dermatitis, rheumatic diseases, vitiligo, uveitis, mycosis fungoides and hypertension; 2) At the Canary Islands, of subtropical maritime climate, climatotherapy for psoriasis, cerebral palsy and atopic dermatitis; 3) At the Alpine mountain area, of moderate- and high-altitude mountain climate, bronchial asthma, atopic eczema, chronic obstructive pulmonary disease (COPD), circulatory diseases, osteoporosis and metabolic syndrome; 4) At the North Sea, climatotherapy for bronchial asthma and atopic dermatitis; 5) At the Baltic Sea, climatotherapy for bronchial asthma, chronic bronchitis, psoriasis, pulmonary silicosis and children after rheumatic disease; 6) At the Island of Jerba in Tunisia, of the Mediterranean maritime climate, climatotherapy for fibromyalgia; 7) At the Adriatic Sea shore in Croatia, climatotherapy for bronchial asthma; 8) At the Black Sea shore, including Evpatoria health resort (Crimea), Azov Sea zone, Black Sea health resort and Sochi health resort, climatotherapy for chronic dermatoses, atherosclerosis, coronary heart disease, rheumatic heart disease, after lung resection in children and non-organized vacationers; 9) At the west coast of Caspian Sea shore, climatotherapy for cerebrovascular disorder; 10) At the mountain hospital in Kyrgyz, of high-altitude mountain climate, aplastic anaemia and idiopathic thrombocytopenic purpura; 11) At the north shore of Sea of Japan, climatotherapy for the children with oncological disease.   In Japan, the total length of coastline is 35,558 km, and the total number of islands is 6,852. The percentage of forest area is 66.4%, moderate-altitude mountain area (250-1,000m above sea level) is 45.0% and high-altitude mountain area (1,000-3,000m) is 6.4%. Climatic region distributes from the subtropical zone to the subarctic zone. Most of the coastal area is close to the mountain area. There are many health resorts for the forest therapy, balneotherapy and thalassotherapy. Conclusions: There would be a high potential of Japanese climate and geographical features as a health resort of climatotherapy and terrain kur to health promotion and disease prevention.

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  We used the data published recently by a team headed by the late Professor Shaul Sukenik, in order to shed light on the huge amount of work realized by this exceptional physician, who devoted his life to his family, his profession and the Dead Sea. <BR>  Particularly, he wanted very early - and always succeeded - to apply the strictest rules of clinical studies in the fields of Balneotherapy and Spa treatment, thus lifting them up to their highest level of credibility. Thanks to his works, one can stipulate with authority that Dead Sea treatments are beneficial in several rheumatologic disease and have a good safety profile.<BR>  The Dead Sea, the deepest and most saline lake on earth, has been known from biblical times for its healing properties. The systematic review presented critically the level of evidence for the claims of therapeutic effects of Dead Sea treatments in several rheumatologic, skin and lung diseases and, as well, reviewed these treatments’ safety.<BR>  The authors found bona fide evidence that Dead Sea treatments are especially effective in psoriasis due to both special characteristics of solar ultraviolet radiation and Dead Sea water balneotherapy. Dead Sea mud and balneotherapy have been found to be beneficial in rheumatologic diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and knee osteoarthritis.<BR>  In the safety analysis, no evidence was found for an increase in skin neoplasia, although skin actinic damage seems to be amplified in patients treated in the Dead Sea. Dead Sea treatments do not lead to worsening of high blood pressure. Substantial ingestion of Dead Sea water (generally in unusual near-drowning cases) is toxic and can result in cardiac rhythm disturbances because of electrolyte concentration abnormalities. Finally, laboratory analysis of Dead Sea mud did not reveal mineral concentrations that could represent a health concern for their intended use.