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The mineralogy, geochemistry and physical and physicochemical properties of three Spanish clays and their mixtures with distilled water were determined. These results were compared with the data obtained by other authors for peloids from spas in Spain and Turkey. The main clay minerals of the samples studied were montmorillonite in Clay1, saponite in Clay2 and kerolite–stevensite in Clay3. The results obtained showed that all three clays share some properties with clays already in use, but Clay1 and Clay2, that are quite rich in smectite, are more suitable when the typical smectite features are needed for therapy. The peloid from saponite was the most suitable for thermotherapy while the kerolite–stevensite sample was not suitable for the preparation of peloids for this use. [ABSTRACT FROM AUTHOR]

Objective: The impact of cervical cancer treatment on the quality of life of long-term survivors compared with the general female population is controversial, and no studies have been conducted comparing patients with benign gynecological diseases. The aim of this study was to compare the quality of life of cervical cancer survivors with that of healthy controls., Study Design: A case-control study was conducted to compare the quality of life of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a healthy woman check-up (n 46) or for a benign gynecological disorder (symptomatic, n 113; asymptomatic, n 26). To measure quality of life, self-administered questionnaires, such as the Functional Assessment Cancer Therapy-cervix and World Health Organization quality of life-brief version, were employed. Baseline scores were collected when patients first reported, and further evaluations were completed at 0-6, 7-12, 13-24, 25-60, and more than 60 months. For the contrastive analysis hypothesis, we employed R statistical software., Results: Except for the environment domain at 0-6, 7-12, and 13-24 months (51.52 vs. 60.73, p < 0.0001; 52 vs. 60.73, p < 0.0001; 49.81 vs. 60.73, p < 0.0001, respectively), we found no statistically significant differences in the quality of life between cervical cancer survivors and controls. We did find differences in the physical health domain scores at 0-6 months (60.22 vs. 72.42, p = 0.039) and the social relationships domain scores at 13-24 months (54 vs. 71.42, p = 0.017) between cases and asymptomatic controls., Conclusion: Except for physical well-being, environment and social relationships, which were substantially better for controls, especially in the asymptomatic, long-term cervical cancer survivorśquality of life did not vary from that of controls., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

A protocol study was designed to examine cutaneous behavior after continuous application of a peloid in the dry mineral residue of Lanjarón-Capuchina natural mineral water. This study aims to analyze the biomechanical behavior of normal skin using various non-invasive bioengineering techniques after the application of this peloid. We determine the effects of its application for 3 months on 38 healthy volunteers (41.4 ± 5.9 years, range 32-58) without a previous history of skin diseases by courtmetry, sebumetry, pH-metry, reviscometry, and tewametry. It was shown that the production of cutaneous sebum is significantly reduced by 6%, trans epidermal skin loss (TEWL) by 21%, skin fatigue by 30%, elasticity increased by 19%, firmness by 5%, and a skin redensification by 6% was obtained under these experimental conditions. Disparate and non-significant results were obtained concerning pH and viscoelasticity. Continuous skin care with the Lanjarón-Capuchina natural peloid modifies skin behavior, normalizing sebaceous secretion, favoring the biomechanical properties of the skin and the skin barrier function without modifying skin homeostasis., (© 2023. The Author(s) under exclusive licence to International Society of Biometeorology.)

Balneotherapy comprises the use of natural mineral waters for health and/or well-being purposes. When balneotherapy is offered by the public health system, some countries with Latin-based languages call it social thermalism. The aim of this study is to compare balneotherapy in health systems of Spain, France, Italy, and Portugal. The study involves a qualitative systematic review of the literature using the systematic search flow method. Twenty-two documents, from 2000 to 2022, were included and its findings were described in seven categories: the first outlines the historical characterization of social thermalism in the systems analyzed and the others outline the components of the health systems: coverage/access, health financing, workforce, inputs and techniques, organization and regulation, and network provision of services. The models of insurance and social security that cover part of the thermal treatment are highlighted. Doctors with competence in medical hydrology constitute the majority of the workforce. Similarities regarding inputs and techniques are observed, with variation in the number of days of the balneotherapy treatment cycle. In the regulation of services, the Ministry of Health of each country is prominent. The provision of services is mainly performed in specialized care in accredited balneotherapy establishments. Despite the limitations of the method, the comparisons made may serve to support public policies for balneotherapy., (© 2023. The Author(s) under exclusive licence to International Society of Biometeorology.)

We sought to determine the prevalence of female sexual dysfunction (FSD) and to examine the influence of age, menopausal state and quality of life (QoL) on the female sexual function (FSF) of healthy women and those with benign gynaecological disease. With this purpose, we conducted a cross-sectional study, based on self-report questionnaires (sociodemographic, WHOQOL-BREF and FSFI), enrolling 107 women. Some 51.6% ( n  = 55) were diagnosed with FSD. We found no statistical significant differences between grouped reason for consultation and FSFI total score ( p  = .72) and its domains ( p  > .05). The results showed a negative strong correlation between age and FSFI total score (S= -0.71) and a positive moderate correlation between WHOQOL-BREF and FSFI total scores (S = 0.39). We observed statistically significant differences between menopausal state and FSFI total score ( p  = .001). In conclusion, the prevalence of FSD in our population was 51.6%. Our study results reveal that a reduction in FSFI scores has a negative impact on QoL and vice versa, regardless of the reason for consultation. Elderly age and postmenopausal state have deleterious effects on FSF.Impact statement What is already known on this subject? Poor QoL can adversely affect FSF and vice versa. The study of FSF is relatively recent and there is controversy regarding the deleterious effects of elderly age and menopause on FSF. The prevalence of FSD is difficult to precisely determine, given the studies' use of different definitions for FSD and the highly heterogeneous study populations, as well as the types of tests and questionnaires employed. Sexual difficulties are problems seldom discussed between patients and their physicians. Lack of time, misconceptions, shame and frustration, considering sexuality as too intimate to discuss in the doctor's office, uncertainty regarding therapeutic options and insufficient training of health professionals are just some of the reasons mentioned for not addressing sexual dysfunction in a general consultation. What do the results of this study add? Our study is the first research in Spain on the impact of age, menopause and QoL on gynaecological patients´ FSF. Our results indicate that an impaired FSF could be related to poorer well-being and QoL; however, benign gynaecological disease does not appear to affect FSF. Elderly age and postmenopausal state can have deleterious effects on FSF. What are the implications of these findings for clinical practice and/or further research? Sexuality is an important aspect of QoL. Therefore, gynaecologists should discuss issues of sexuality with their patients in routine visits, especially in case of elderly and postmenopausal women. In addition, gynaecologists should train in the diagnosis and treatment of the female sexual dysfunction.

Background: Lymphatic disorders are frequent complications related to treatment for cervical cancer (CC). The aims of the study are to evaluate the impact of lymphatic disorders on quality of life (QOL) and sexuality in CC survivors after the completion of oncological treatment and to compare them with controls. Methods and Results: An ambispective cohort study was performed by using the Functional Assessment Cancer Therapy (FACT)-Cervix (Cx) fourth version, the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), and the Female Sexual Function Index (FSFI). Twelve patients affected by lymphatic disorders comprised the study group, 251 comprised the CC control group, and 185 comprised the non-CC control group. Regarding QOL, there were no statistically significant differences between the lymphatic disorder-unaffected and non-CC control groups, except in the WHOQOL-BREF environment domain. A weak positive correlation between lymphatic disorder and FACT-Cx additional concerns (σ = 0.135) was observed. Regarding sexuality, a weak negative correlation was detected between lymphatic disorders and FSFI sexual satisfaction (σ = -0.200) and a weak positive correlation was observed between lymphatic disorders and FSFI dyspareunia (σ = 0.148). We did not observe statistically significant differences in QOL satisfaction between the lymphatic disorder-affected and non-CC control groups. Symptomatic controls reported significantly higher physical health scores than the lymphatic disorder-affected group ( p  < 0.05). Regarding the psychological domain, the asymptomatic controls obtained significantly higher scores than the lymphatic disorder-affected group ( p  = 0.003). Conclusions: Lymphatic disorders notably influenced the QOL of CC survivors compared with the non-CC control groups. Lymphatic disorders had a significant negative impact on physical and psychological health. Sexuality was scarcely affected by lymphatic disorders.

Since knowledge concerning the cellular and tissue substrate that explains the therapeutic action of mineral waters is generally very scarce, we address the different effects that Lanjarón-Capuchina mineral water exerts on the intestinal epithelium in an experimental model as a prototype of the sodium chloride-rich mineral waters used in digestive disorders. In the experimental protocol, two groups of five adult Wistar rats received unrestricted mineral water in their diet or mineral water directly into the gastrointestinal tract through a catheter. A third control group was given a standard diet and water ad libitum. Intestinal samples for scanning electron microscopy were analyzed according to standardized methods. The observations carried out by microscope after the administration of the sodium chloride-rich mineral water clearly indicate that the hypertonic action of this mineral water affects the structure of the intestinal epithelium. It modifies the microvilli absorption in terms of the groups of enterocytes and the secretion of goblet cells, but it particularly affects the epithelial renewal process, accelerating and stimulating cell extrusion. The type of extrusion mechanism observed by microscope allows us to affirm that, although this increased after direct administration, it does not generate an epithelial disruption as it occurs in other circumstances with other extrusion modalities.

The use of peloids as heat-providing therapeutic systems dates back to antiquity. Such systems consist of a liquid phase and an organic or inorganic solid phase. The latter facilitates the handling, preparation and stability of the solid-liquid system, modifying its organoleptic and phy-sicochemical properties, and improves its efficacy and tolerance. Peloids enable the application of heat to very specific zones and the release of heat at a given rate. The aims of this work are to study 16 reference peloids used in medical spa centers as thermo-therapeutic agents as well as to propose nine raw materials as a solid phase for the preparation of peloids. The physical properties studied are the centesimal composition, the instrumental texture and the thermal parameters. In conclusion, the peloids of the medical spas studied are used as thermotherapeutic agents in the treatment of musculoskeletal disorders, especially in knee osteoarthritis and to a lesser extent in back pain and psoriatic arthropathy. The clinical experience in these centers shows that the main effects of the application of their peloids are the reduction of pain, an increase in the joint's functional capacity and an improvement in the quality of life. As thermotherapeutic agents, all the peloids of the me-dical spas studied and the pastes (raw materials with distilled water) examined showed a heat flow rate of up to four times lower than that shown by the same amount of water. The raw materials studied can be used as solid phases for the preparation of peloids with mineral waters.

Strokes are a leading cause of disability in developed countries. Patients with disabilities need rehabilitation to improve their physical functioning, mental status, and quality of life. Currently, no high-quality evidence can be found attesting the benefits of any of the interventions that are nowadays used. Water-based exercise may improve the physical conditions and quality of life of people in the post-stroke phase. The objective of this study is to test whether aquatic therapy in an enriched environment at the seaside (a thalassotherapy center) could play a role in this condition. A quasi-experimental prospective study consisting of a specific program assessed 62 patients with a mild-moderate disability pre- and post-2 weeks of intensive treatment. They followed a thalassotherapy regimen including aquatic therapy in a sea water pool at 32-34 °C for 45 min daily five times a week. The outcomes measured were the Berg Balance scale, the Timed Up and Go test, the 10-meter walking test, the 6-min walking test, the Pain Visual Analogue Scale, the WHO Well-being index, EuroQoL VAS and EuroQoL 5D. We observed a significant improvement in all outcomes measured ( p < 0.001, except mobility EuroQoL p < 0.05), except in the other four dimensions of the EuroQoL 5D and 10-metre walking test (NS). Conclusion: A two-week intensive course of aquatic therapy and thalassotherapy may be beneficial in the short term by reducing pain and improving the functional status and overall well-being of post-stroke patients.

This study systematically reviews the current state of aquatic treatment of neck pain and assesses the scientific evidence of its benefits. The databases PubMed, Scopus, Web of Science and PEDro were searched for relevant reports published from January 1, 2008, to November 7, 2017, using the keywords "neck pain" in addition to "balneotherapy", "spa treatment", "spa", "thalassotherapy", "hydrotherapy", "aquatic therapy" or "aquatic". Inclusion criteria were full-text articles published in journals included in Journal Citation Reports in English and Spanish describing human studies. Case studies, letters to the editor and meeting presentations or other contributions were excluded. Of 367 articles identified, only 13 fulfilled the inclusion criteria: 5 randomized trials, 1 single blind controlled study, 2 pilot studies, 2 observational retrospective studies, 1 prospective study, 1 clinical study and 1 not specified. Participants were 658 subjects with chronic neck pain. Main symptoms and signs treated were neck pain, disability, cervical disc herniation and compromised quality of life. Evidence that aquatic treatment improves quality of life in affected individuals was good in four studies, fair in eight and weak in one. Treatment of neck pain using different waters and techniques reduced pain and disability, and improved functional capacity, quality of life, joint mobility, balance, relaxation and mood.

Osteoarthritis of the knee joint is a public health concern with considerable social impacts and related-costs. Among the treatments available, several benefits of bathing in natural mineral water have been proposed: (1) to identify possible health benefits (in terms of effects on dimensions of pain, functionality, emotional and social aspects, and quality of life) of a 3-week balneotherapy intervention in patients with knee osteoarthritis; (2) to assess the clinical relevance of any benefits detected; and (3) to determine if these effects persist. Participants of this randomized controlled trial (RCT) were 120 patients randomly assigned to (1) an experimental group (3 weeks of balneotherapy consisting of daily whirlpool baths, hydrokinesitherapy sessions, and knee shower/massages) or (2) control group in which no form of treatment apart from their usual analgesia medication was given. Treatment benefits were assessed using the following tools: (1) visual analogue scale (VAS) of pain, (2) Timed Up & Go Test (TUG), (3) WOMAC osteoarthritis questionnaire, and (4) SF 36 health survey questionnaire. In the experimental group, these tests were conducted immediately before treatment, immediately after treatment, and at 3 months of follow-up. Patients assigned to the control group were assessed at the study start and 3 months later. Data processing and statistical analysis were performed using the SPSS (Statistical Package for Social Science) version 22.0. Out of 60 patients in the experimental group, 45 were found to benefit from the treatment intervention in terms of pain relief among other aspects, and also when test scores were compared to those obtained in the control group. Improvements were often clinical relevant and in most patients persisted 3 months after treatment onset.

The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V ( p  < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) ( p  > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.

Background and Objective: Sentinel lymph node biopsy (SLNB) was created to reduce the morbidity associated with pelvic lymphadenectomy in the early stages of cervical cancer (CC), preserving its prognostic information. The goal is to assess the diagnostic validity of SLNB in CC in initial stages (IA1 with lymphovascular infiltration (LVI) +, IA2, IB1 and IIA1), thus avoiding unnecessary lymphadenectomies in many of the cases., Material and Method: From January 2012 to April 2017, 23 patients with initial stages of CC were included in a cross-sectional study to evaluate the effectiveness of the SLNB in CC with a mixed technique of cervical injection of 99m Tc-nanocolloid of albumin and methylene blue, using combined planar lymphoscintigraphy with multimodality SPECT/CT image and subsequent removal of the sentinel node (SN) by laparoscopy., Results: The detection rate of SLNB with the mixed technique was 95.65%, with a negative predictive value (NPV) of 95.45% and sensitivity (S) of 100% in the case of bilateral drainage. The mean of excised SN was 3 (range 1-5). The bilateral detection rate in laparoscopy was 85.35%. The concordance between SPECT/CT and laparoscopy for the number and bilaterality of the SN using the Pearson coefficient was r = 0.727 and r = 0.833, respectively; p = 0.01. We only found one SN with a deferred result of micrometástasis and one false negative was detected., Conclusions: SLNB in CC using a mixed technique has a high detection and bilateral drainage rate, but S is still low if we include cases of unilateral drainage. A greater number of cases and the development of intraoperative ultrastaging could increase the S of the technique and to reduce the number of false negatives., (Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

In Health Resort Medicine, both balneotherapy and thalassotherapy, salt waters and their peloids, or mud products are mainly used to treat rheumatic and skin disorders. These therapeutic agents act jointly via numerous mechanical, thermal, and chemical mechanisms. In this review, we examine a new mechanism of action specific to saline waters. When topically administered, this water rich in sodium and chloride penetrates the skin where it is able to modify cellular osmotic pressure and stimulate nerve receptors in the skin via cell membrane ion channels known as "Piezo" proteins. We describe several models of cutaneous adsorption/desorption and penetration of dissolved ions in mineral waters through the skin (osmosis and cell volume mechanisms in keratinocytes) and examine the role of these resources in stimulating cutaneous nerve receptors. The actions of salt mineral waters are mediated by a mechanism conditioned by the concentration and quality of their salts involving cellular osmosis-mediated activation/inhibition of cell apoptotic or necrotic processes. In turn, this osmotic mechanism modulates the recently described mechanosensitive piezoelectric channels.

The aims of this study were to conduct a systematic literature review on balneotherapy about the specific therapeutic role of mineral elements and other chemical compounds of mineral waters and derivate peloids/muds and to discuss the study methods used to evaluate it (in musculoskeletal conditions). We searched Medline by PubMed using the following key words: "spa therapy" "balneotherapy" "mud" "peloid" "mud pack Therapy" in combination with "randomized controlled trial" "double blind trial." We also reviewed the reference list of articles retrieved by the Medline search. We selected the double-blind randomized clinical trials that assessed the effects of mineral water or mud treatments compared to tap water, attenuated peloid/mud therapy or similar treatments without the specific minerals or chemical compounds of the treatment group ("non-mineral"). We evaluated the internal validity and the quality of the statistical analysis of these trials. The final selection comprised 27 double-blind randomized clinical trials, 20 related to rheumatology. A total of 1118 patients with rheumatological and other musculoskeletal diseases were evaluated in these studies: 552 of knee osteoarthritis, 47 of hand osteoarthritis, 147 chronic low back pain, 308 of reumathoid arthritis, and 64 of osteoporosis; 293 of these participants were assigned to the experimental groups of knee osteoarthritis, 24 in hand osteoarthritis, 82 of low back pain, 152 with reumathoid arthritis, and 32 with osteoporosis. They were treated with mineral water baths and/or mud/peloid (with or without other forms of treatment, like physical therapy, exercise…). The rest were allocated to the control groups; they received mainly tap water and/or "non-mineral" mud/peloid treatments. Mineral water or mud treatments had better and longer improvements in pain, function, quality of life, clinical parameters, and others in some rheumatologic diseases (knee and hand osteoarthritis, chronic low back pain, rheumatoid arthritis, and osteoporosis) compared to baseline and non-mineral similar treatments. Internal validity and other limitations of the study's methodology impede causal relation of spa therapy on these improvements. Randomized clinical trials are very heterogeneous. Double-blind randomized clinical trials seem to be the key for studying the role of mineral elements and other chemical compounds, observing enough consistency to demonstrate better and longer improvements for mineral waters or derivate compared to tap water; but due to heterogeneity and gaps on study protocol and methodology, existing research is not sufficiently strong to draw firm conclusions. Well-designed studies in larger patients' population are needed to establish the role of minerals and other chemical compounds in spa therapy.

Introduction: Multiple sclerosis (MS) is a chronic, inflammatory, progressive, disabling autoimmune disease affecting the central nervous system. Symptoms and signs of MS vary widely and patients may lose their ability to walk. To date the benefits of aquatic therapy often used for rehabilitation in MS patients have not been reviewed. The aim of this study was to systematically review the current state of aquatic treatment for persons with MS (hydrotherapy, aquatic therapy, aquatic exercises, spa therapy) and to evaluate the scientific evidence supporting the benefits of this therapeutic option., Evidence Acquisition: The databases PubMed, Scopus, WoS and PEDro were searched to identify relevant reports published from January 1, 2011 to April 30, 2016., Evidence Synthesis: Of 306 articles identified, only 10 fulfilled the inclusion criteria: 5 randomized controlled, 2 simple randomized quasi-experimental, 1 semi-experimental, 1 blind controlled pilot and 1 pilot., Conclusions: Evidence that aquatic treatment improves quality of life in affected patients was very good in two studies, good in four, fair in two and weak in two.

Introduction: Stroke remains the leading cause of acquired disability. Health and social planning and management may vary and although prevention is crucial, having better treatments and strategies to reduce disability is needed., Aim: To determine the effect of an intensive program of thalassotherapy and aquatic therapy in stroke patients, valuing clinical parameters and functional validated scales., Patients and Methods: A quasi-experimental prospective study consisting of a specific program assessed pre- and post- 3 weeks treatment to 26 stroke patients with a mild-moderate disability. The outcomes measured were: Berg Balance scale, Timed Up and Go test, 10-meter walking test, 6-minute walking test and pain Visual Analogue Scale., Results: After intervention, participants had a significant improvement in all outcomes measured., Conclusions: Our results suggest that an intensive program of thalassotherapy and aquatic therapy could be useful during stroke rehabilitation to improve balance, gait and pain.

Sulphurous mineral waters have been traditionally used in medical hydrology as treatment for skin, respiratory, and musculoskeletal disorders. However, driven by recent intense research efforts, topical treatments are starting to show benefits for pulmonary hypertension, arterial hypertension, atherosclerosis, ischemia-reperfusion injury, heart failure, peptic ulcer, and acute and chronic inflammatory diseases. The beneficial effects of sulphurous mineral waters, sulphurous mud, or peloids made from sulphurous mineral water have been attributed to the presence of sulphur mainly in the form of hydrogen sulphide. This form is largely available in conditions of low pH when oxygen concentrations are also low. In the organism, small amounts of hydrogen sulphide are produced by some cells where they have numerous biological signalling functions. While high levels of hydrogen sulphide are extremely toxic, enzymes in the body are capable of detoxifying it by oxidation to harmless sulphate. Hence, low levels of hydrogen sulphide may be tolerated indefinitely. In this paper, we review the chemistry and actions of hydrogen sulphide in sulphurous mineral waters and its natural role in body physiology. This is followed by an update of available data on the impacts of exogenous hydrogen sulphide on the skin and internal cells and organs including new therapeutic possibilities of sulphurous mineral waters and their peloids.

Objective: To determine nitrate concentrations in drinking water in a sample of Spanish cities., Material and Methods: We used ion chromatography to analyze the nitrate concentrations of public drinking water in 108 Spanish municipalities with more than 50,000 inhabitants (supplying 21,290,707 potential individuals). The samples were collected between January and April 2012. The total number of samples tested was 324., Results: The median nitrate concentration was 3.47 mg/L (range: 0.38-66.76; interquartile range: 4.51). The water from 94% of the municipalities contained less than 15 mg/L. The concentration was higher than 25mg/L in only 3 municipalities and was greater than 50mg/L in one., Conclusions: Nitrate levels in most public drinking water supplies in municipalities inhabited by almost half of the Spanish population are below 15 mg/L., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Introduction: An appropriate magnesium intake has proved to have beneficial effects on bone health, reduce insulin resistance and prevent atherosclerosis., Objective: To determine the concentration of magnesium in drinking water and bottled mineral water in Spain and assess its daily contribution to dietary recommendations., Methods: We used ion chromatography to analyse the magnesium concentrations of public drinking waters in a representative sample of 108 Spanish municipalities (supplying 21,290,707 potential individuals) and 109 natural mineral waters sold in Spain (97 Spanish and 12 imported)., Results: The water generally contained between 15 and 45 mg/L of magnesium, but in seven municipalities it contained over 45 mg/L. The average magnesium concentration of 97 brands of Spanish natural mineral water was 16.27 mg/L (range: 0.11-141.2 mg/L). Of these, 33 contained between 15 and 45 mg/L of magnesium and four contained over 45 mg/L. Of the 12 imported brands, 4 contained over 45 mg/L. Assuming water consumption is as recommended by the European Food Safety Agency, water containing 15 to 45 mg/L of magnesium provides between 9 and 76.5% of the recommended intake of magnesium for children aged one to thirteen, up to 25.7% in adolescents, between 7.5 and 25.7% for adults, and up to 27% for lactating women. Water with 60 mg/L of magnesium provides between 30 and 102% of the recommended dietary allowance, depending on the age of the individual., Discussion: The consumption of public drinking water and natural mineral water in a third of Spanish cities can be regarded as an important supplementary source of magnesium., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Aim: The aim of the study was to determine the concentration of fluoride in natural mineral waters marketed in Spain in order to prevent tooth decay without the risk of causing dental fluorosis, Design: Descriptive and cross-sectional study during 2012., Location: Natural mineral waters marketed in Spain., Participants: Three bottles with different bottling dates of 109 natural mineral waters (97 Spanish and 12 imported brands)., Main Measures: Determination of fluoride by ion chromatography, Results: Median fluoride concentrations of the natural mineral waters bottled in Spain was 0.22 (range 0.00-4.16; interquartile range:0.37). Most samples (61 brands, 62%) contained less than 0.3mg/L. There are 19 Spanish brands with more than 0.6 mg/L. The median level in imported brands was 0.35 (range 0.10-1.21; interquartile range: 0.23). Only 28 of the 109 brands examined (25.6%) specified the fluoride content on the label. Good correlation was observed between the concentrations indicated and those determined., Conclusions: Fluoride concentrations in natural mineral waters showed high variation. Given the growing consumption of natural mineral waters in Spain, this type of information is important to make proper use of fluoride in the primary prevention of dental caries., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Introduction: A sufficient intake of calcium enables correct bone mineralization. The bioavailability of calcium in water is similar to that in milk., Objective: To determine the concentration of calcium in public drinking water and bottled mineral water., Methods: We used ion chromatography to analyse the calcium concentrations of public drinking waters in a representative sample of 108 Spanish municipalities (21,290,707 people) and of 109 natural mineral waters sold in Spain, 97 of which were produced in Spain and 12 of which were imported., Results: The average calcium concentration of public drinking waters was 38.96 ± 32.44 mg/L (range: 0.40- 159.68 mg/L). In 27 municipalities, the water contained 50-100 mg/L of calcium and in six municipalities it contained over 100 mg/L. The average calcium concentration of the 97 Spanish natural mineral water brands was 39.6 mg/L (range: 0.6-610.1 mg/L). Of these, 34 contained 50-100 mg/L of calcium and six contained over 100 mg/L. Of the 12 imported brands, 10 contained over 50 mg/L. Assuming water consumption is as recommended, water containing 50-100 mg/L of calcium provides 5.4-12.8% of the recommended intake of calcium for children aged one to thirteen, up to 13.6% for adolescents, 5.8-17.6% for adults, and up to 20.8% for lactating mothers. Water with 100-150 mg/L of calcium provides 10-31% of the recommended dietary allowance, depending on the age of the individual., Discussion: Public drinking water and natural mineral water consumption in a third of Spanish cities can be considered an important complementary source of calcium., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)