Bathing Frequency and Onset of Functional Disability Among Japanese Older Adults: A Prospective 3-Year Cohort Study From the JAGES.

BACKGROUND: While bathing styles vary among countries, most Japanese people prefer tub bathing to showers and saunas. However, few studies have examined the relationship between tub bathing and health outcomes. Accordingly, in this prospective cohort study, we investigated the association between tub bathing frequency and the onset of functional disability among older people in Japan. METHODS: We used data from the Japan Gerontological Evaluation Study (JAGES). The baseline survey was conducted from August 2010 through January 2012 and enrolled 13,786 community-dwelling older people (6,482 men and 7,304 women) independent in activities of daily living. During a 3-year observation period, the onset of functional disability, identified by new certification for need of Long-Term Care Insurance, was recorded. Tub bathing frequencies in summer and winter at baseline were divided into three groups: low frequency (0-2 times/week), moderate frequency (3-6 times/week), and high frequency (≥7 times/week). We estimated the risks of functional disability in each group using a multivariate Cox proportional hazards model. RESULTS: Functional disability was observed in a total of 1,203 cases (8.7%). Compared with the low-frequency group and after adjustment for 14 potential confounders, the hazard ratios of the moderate- and high-frequency groups were 0.91 (95% confidence interval [CI], 0.75-1.10) and 0.72 (95% CI, 0.60-0.85) for summer and 0.90 (95% CI, 0.76-1.07) and 0.71 (95% CI, 0.60-0.84) for winter. CONCLUSION: High tub bathing frequency is associated with lower onset of functional disability. Therefore, tub bathing might be beneficial for older people's health.

Determining the general utilization and characteristics of orthopedic complementary and alternative medicine using a self-administered online questionnaire in Japan.

BACKGROUND: Acupuncture and moxibustion, massage, bone-setting, manual therapy, and chiropractic treatments are representative components of orthopedic complementary and alternative medicine (OCAM) in Japan. However, the state of their utilization and characteristics are unclear, and have yet to be thoroughly surveyed. The objective of this study was to survey the utilization and characteristics of OCAM in the general public. MATERIALS AND METHODS: In January 2011, we conducted a self-administered online questionnaire survey with 10,400 members of the general public, who were registered as consumer reviewers at the internet survey company. Survey topics were the use of OCAM within one month prior to the survey, the objective of using OCAM, and the presence or absence of consultation with and recommendation or referral by a physician. The subjects were divided into those who used and did not use OCAM as user and non-user groups, respectively, and the age, sex, and prevalence of past treatment for orthopedic diseases at medical institutions were compared between the groups. Data of 3,211 subjects (1,611 males and 1,600 females, mean age: 44.7 years old) were analyzed. RESULTS: Four hundred and thirty-eight subjects (13.6%) used OCAM within one month prior to the survey. The subjects in their forties used OCAM most frequently, followed by those in their twenties. The most frequent objective of OCAM usage was treatment, accounting for 63% (275 subjects) of the subjects. Fifty-three subjects (12.1%) consulted a physician, and 48 (11%) were recommended or referred by a physician. Upon logistic regression analysis, significant differences were detected in age, sex, and prevalence of treatment at a medical institution in the user group. A decreasing trend in the odds ratio correlated with subjects having received previous treatment at a medical institution, female subjects, and subjects of a younger age (p = 0.01; odds ratio = 4.33, 1.43, and 1.01, respectively), and these factors were independent. CONCLUSION: It was determined that 13.6% of the subjects had used OCAM, and many relatively young females (especially those in their forties or twenties) with a past medical history used it based on their own judgment.

Changes in blood coagulation-fibrinolysis markers by pneumatic tourniquet during total knee joint arthroplasty with venous thromboembolism.

This study investigated changes in blood coagulation-fibrinolysis markers during total knee arthroplasty (TKA). Preoperative 16-row multidetector row computed tomography (MDCT) revealed no asymptomatic venous thromboembolism (VTE) in the 42 patients recruited. Using MDCT postoperatively, patients were divided into thrombus (asymptomatic VTE, 19 patients) and no-thrombus (23 patients) groups. Blood taken at intervals before and after pneumatic tourniquet release revealed increased plasminogen activator inhibitor type-1 (PAI-1) at 30s for both groups and at 90s (both P=0.01) in the thrombus group. D-dimer levels were highest at 30 and 90s for both groups (P = 0.01). PAI-1 and D-dimer levels were strongly correlated at both time points in the thrombus group. Inactivating fibrinolysis due to PAI-1 may lead to asymptomatic VTE after TKA.

Consumption of dairy products and death from cardiovascular disease in the Japanese general population: the NIPPON DATA80.

BACKGROUND: Recent Western studies show an inverse association between milk and dairy product intake and cardiovascular disease (CVD). We studied the association between consumption of milk and dairy products and CVD death in Japan. METHODS: Men and women aged 30 years or older were followed for 24 years. All had participated in a national nutrition survey in 300 health districts throughout Japan in 1980. The Cox proportional hazards model was used to assess mortality risk according to tertiles of milk and dairy product intake, with the high consumption group as reference. Hazard ratios (HRs) per 100-g/day increase in consumption were also estimated. RESULTS: During the 24-year follow-up period, there were 893 CVD deaths, 174 deaths from coronary heart disease (CHD), and 417 stroke deaths among 9243 participants. For women, the HRs for death from CVD, CHD, and stroke in the low consumption group were 1.27 (95% CI: 0.99-1.58; P for trend = 0.045), 1.67 (0.99-2.80; P = 0.02), and 1.34 (0.94-1.90; P = 0.08), respectively, after adjustment for age, body mass index, smoking status, alcohol drinking habits, history of diabetes, use of antihypertensives, work category, and total energy intake. With each 100-g/day increase in consumption of milk and dairy products, HRs tended to decrease for deaths from CVD (HR, 0.86; 95% CI, 0.74-0.99), CHD (0.73; 0.52-1.03), and stroke (0.81; 0.65-1.01) in women. No significant association was observed in men. CONCLUSIONS: Consumption of milk and dairy products was inversely associated with CVD death among women in Japan.

Gargling for oral hygiene and the development of fever in childhood: a population study in Japan.

BACKGROUND: Fever is one of the most common symptoms among children and is usually caused by respiratory infections. Although Japanese health authorities have long recommended gargling to prevent respiratory infections, its effectiveness among children is not clear. METHODS: The children in this observational study were enrolled from 145 nursery schools in Fukuoka City, Japan. Children in the exposure group were instructed to gargle at least once a day. The endpoints of this study were incidence of fever during the daytime and incidence of sickness absence. Differences among gargling agents for each endpoint were also analyzed. RESULTS: A total of 19,595 children aged 2 to 6 years were observed for 20 days (391,900 person-days). In multivariate logistic regression, the overall odds ratio (OR) for fever onset in the gargling group was significantly lower (OR = 0.68). In age-stratified analysis, ORs were significantly lower at age 2 (OR = 0.67), 4 (OR = 0.46), and 5 (OR = 0.41) years. Regarding sickness absence, the overall OR was 0.92 (not significant) in the gargling group. In age-stratified analysis, ORs were significantly lower at age 4 (OR = 0.68), 5 (OR = 0.59), and 6 (OR = 0.63) years. In subgroup analysis, significantly lower ORs for fever onset were observed for children who gargled with green tea (OR = 0.32), functional water (OR = 0.46), or tap water (OR = 0.70). However, the ORs were not significant for sickness absence. CONCLUSIONS: Gargling might be effective in preventing febrile diseases in children.

Physical activity and risk of fatal or non-fatal cardiovascular disease among CVD survivors: the JMS cohort study.

BACKGROUND: Although many population-based studies have reported an association between physical activity and cardiovascular disease (CVD) among healthy populations, the association among CVD survivors has been less reported. We examined the relationship between physical activity and CVD risk among survivors. METHODS AND RESULTS: This was a prospective cohort study of 12,490 Japanese participants, including 754 individual CVD survivors. Between April 1992 and July 1995, a baseline survey was conducted in 12 communities in Japan. The mean follow-up period was 11.9 years, during which time 74 individuals had non-fatal CVD and 51 cases were fatal CVD. Among CVD survivors, analysis was performed after exclusion of participants with a history of cancer and those who died within the first 2 years of follow-up. Physical activity was analyzed in tertiles (low, moderate and heavy), and the hazard ratios (HRs) were calculated for non-fatal or fatal CVD among CVD survivors. After setting the low group as the reference, the HRs for non-fatal CVD in the moderate and heavy groups were 0.61 (95% confidence interval: 0.30-1.24) and 0.50 (0.20-1.25) (P for trend = 0.059), respectively, and the HRs for fatal CVD were 0.75 (0.33-1.69) and 0.18 (0.04-0.83) (P for trend = 0.026), respectively. CONCLUSIONS: Physical activity reduced the risk of CVD, both fatal and non-fatal events, among CVD survivors.

Incidence of symptoms and accidents during baths and showers among the Japanese general public.

BACKGROUND: Bathing is a deeply ingrained custom among Japanese; however, data on the incidence rate of symptoms and accidents during bathing have not yet been reported for the Japanese general public. METHODS: We conducted a population-based cross-sectional study of 617 Japanese adults who attended a specialized health checkup. Participants completed a self-administered questionnaire to assess weekly frequencies of bathtub bathing and showering and the frequency of symptoms/accidents (falling, loss of consciousness, and other) during these activities in the past year. We calculated the incidence rates of accidents per 10 000 baths/showers and 95% confidence intervals (CIs) and compared the clinical characteristics of participants who had symptoms/accidents with those who did not. RESULTS: The incidence rates of accidents per 10 000 bathtub baths and showers were 0.43 (95% CI: 0.22-0.84) and 0.24 (95% CI: 0.04-1.37). Although these rates are low, there were 740 000 bathtub bathing-related accidents in Japan, due to the fact that bathing is an almost-daily habit. There was no significant difference in clinical characteristics between groups. CONCLUSIONS: We collected basic information on the incidence of bathing-related accidents in Japan. Falls and loss of consciousness during bathing or showering can potentially lead to a serious accident, so the general public should be educated about the possibility of such accidents during bathing.

Frequency of citrus fruit intake is associated with the incidence of cardiovascular disease: the Jichi Medical School cohort study.

BACKGROUND: It has been reported that fruit intake protects against cardiovascular disease (CVD). However, most of the relevant studies were conducted in Western countries, and only a few investigated Japanese populations. The present cohort study assessed the effect of citrus fruit intake on the incidence of CVD and its subtypes in a Japanese population. METHODS: A baseline examination consisting of physical and blood examinations and a self-administered questionnaire was conducted during the period from April 1992 through July 1995. Dietary habits were assessed using a food frequency questionnaire that was divided into 5 categories. Citrus fruit was examined separately due to its frequent consumption by the general Japanese population. Using the Cox proportional hazards model, data from 10,623 participants (4147 men, 6476 women) who had no history of CVD or carcinoma were analyzed to assess the association between frequency of citrus fruit intake and CVD incidence. RESULTS: Frequent intake of citrus fruit was associated with a lower incidence of CVD: the hazard ratio for almost daily intake versus infrequent intake of citrus fruit was 0.57 (95% confidence interval: 0.33-1.01, P for trend = 0.04) in men and 0.51 (0.29-0.88, P for trend = 0.02) in women. Frequent intake of citrus fruit was also associated with lower incidences of both all stroke and cerebral infarction, but not hemorrhagic stroke or myocardial infarction. CONCLUSIONS: Frequent intake of citrus fruit may reduce the incidence of CVD, especially cerebral infarction, in men and women.

The incidence of venous thromboembolism before and after total knee arthroplasty using 16-row multidetector computed tomography.

We performed a prospective study to determine the incidence of venous thromboembolism (VTE) using 16-row multidetector computed tomography (MDCT). The study included 71 patients who underwent total knee arthroplasty between September 2004 and March 2009. Multidetector computed tomography was performed 4 days before and after surgery. No patient had any presurgical symptoms of VTE. Presurgical and postsurgical incidences of pulmonary thromboembolism plus deep vein thrombosis were 0% and 13%, respectively; pulmonary thromboembolism alone, 1% and 3%, respectively; and deep vein thrombosis alone, 8% and 34%, respectively. Because asymptomatic VTE was noted in 9% of patients before surgery and 51% after surgery, we conclude that performing MDCT before and after total knee arthroplasty may be useful to clarify the incidence of VTE and to develop appropriate strategies for treatment and prevention.

Physical activity and cardiovascular disease in Japan: the Jichi Medical School Cohort Study.

BACKGROUND: Many studies have reported an association between physical activity and cardiovascular disease (CVD); however, the effect of physical activity remains controversial. Few such studies have been conducted in Japan. Therefore, we examined the relationship between physical activity and death from CVD using prospective data from a Japanese population. METHODS: From a prospective cohort study that comprised 12 490 participants, data from 9810 were analyzed. From April 1992 through July 1995, a baseline survey was conducted in 12 communities in Japan. The participants were followed up until December 2005. Physical activity was assessed using the physical activity index (PAI). PAI scores were grouped in quartiles: Q1 was the lowest PAI quartile and Q4 was the highest. Hazard ratios (HRs) for death from CVD, stroke, and myocardial infarction (MI) were calculated for all PAI quartiles. RESULTS: The mean follow-up period was 11.9 years, during which time 194 participants died of CVD. With Q1 as the reference, the HRs for death from CVD in Q2, Q3, and Q4, were 0.62 (95% confidence interval, 0.40-0.98), 0.53 (0.31-0.88), and 0.40 (0.22-0.73), respectively, in men, and 0.71 (0.38-1.32), 0.52 (0.26-1.04), and 0.48 (0.22-1.05), respectively, in women. The HRs for death from CVD subtypes were similar but not statistically significant. CONCLUSIONS: Among a Japanese population, physical activity was associated with a decreased risk of death from CVD. However, more evidence is needed to elucidate the relationships between physical activity and CVD subtypes.

Physical activity and all-cause mortality in Japan: the Jichi Medical School (JMS) Cohort Study.

BACKGROUND: In April 2008, a new health check-up and health guidance system was introduced by the Japanese Government to promote increased physical activity. However, few studies have documented the health benefits of physical activity in Asian populations. We examined the association between all-cause mortality and level of physical activity in a Japanese multicommunity population-based study. METHODS: The Jichi Medical School Cohort Study is a multicommunity, population-based study based in 12 districts in Japan. Baseline data from 4222 men and 6609 women (mean age, 54.8 and 55.0 years, respectively) were collected between April 1992 and July 1995. The participants were followed for a mean duration of 11.9 years. To determine the association between all-cause mortality and level of physical activity, crude mortality rates per 1000 person-years and hazard ratios (HRs) with 95% confidence intervals (CI) were determined using the Cox proportional hazards model. Physical activity was categorized by using physical activity index (PAI) quartiles. The lowest (first) PAI quartile was defined as the HR reference. RESULTS: In men, the lowest mortality rate was observed in the third quartile, with 95 deaths and a crude mortality rate of 7.6; the age- and area-adjusted HR was 0.59 (95% CI, 0.45-0.76), and the mortality curve had a reverse J shape. In women, the lowest mortality rate was observed in the highest PAI quartile, with 69 deaths and a crude mortality rate of 3.5; the HR was 0.81 (95% CI, 0.58-1.12). CONCLUSION: Our results suggest that increased physical activity lowers the risk for all-cause death in Japanese.

The health impact of remarriage behavior on chronic obstructive pulmonary disease: findings from the US longitudinal survey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major disease among adults, and its deterioration was reported to be associated with psychological imbalance. Meanwhile, bereavement and divorce have proven harmful to the health status of a surviving spouse. But few studies have been conducted to evaluate the remedial effect on survivors' health outcome by remarriage after bereavement. The present study thus examined the associations between remarriage and the onset of COPD. METHODS: Our cohort was drawn from Health and Retirement Study participants in the United States, and consisted of 2676 subjects who were divorced or bereaved from 1992 to 2002. We then followed them for up to 11 years and assessed the incidence rate of COPD using a Cox proportional hazard model after adjusting for marital status, age, gender, education and the number of cigarettes smoked. RESULTS: Among all subjects, 224 who remarried after bereavement or divorce tended to be younger and more male dominated. Remarriage after bereavement/divorce was associated with significantly decreased risk of COPD onset for overall subjects [hazard ratio (HR): 0.51, 95% confidence interval (95% CI): 0.28-0.94], female subjects [HR: 0.36, 95% CI: 0.13-0.98], and for those under 70 years old [HR: 0.36, 95% CI: 0.17-0.79]. CONCLUSION: This study investigates the impact of remarriage on health outcome based on a large-scale population survey and indicates that remarriage significantly correlates with reduced risk of COPD incidence, even after adjusting smoking habit.

Effects of charcoal kiln saunas (Jjimjilbang) on psychological states.

This uncontrolled intervention study explored the effects of sauna bathing utilizing residual heat from charcoal kilns (charcoal kiln saunas) on psychological states. Forty-five volunteers (24 males and 21 females; mean age 51.9 years (S.D. 15.7) visiting a bamboo charcoal kiln in Japan participated in the study. They completed a shortened version of the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) before and after charcoal kiln sauna bathing in order to determine mood and anxiety states. Six factors relating to mood were measured using the POMS: Tension-Anxiety, Depression-Dejection, Anger-Hostility, Vigor, Fatigue, and Confusion. The two anxiety concepts of state anxiety and trait anxiety were also measured. Changes in psychological states before and after sauna bathing were then determined. All mood scales and both manifest anxiety measures were improved after sauna bathing. Charcoal kiln sauna bathing appears to improve mood and decrease anxiety. It is a limitation of this study that this was a descriptive prospective and an uncontrolled intervention study. Further investigation of the improvement of trait anxiety is required.

Physical and Mental Effects of Bathing: A Randomized Intervention Study.

Showering is the most common form of bathing worldwide. Whole-body immersion bathing in warm water (~40°C) is common in Japan and exerts sufficient hyperthermic action to induce vasodilatation and increase blood flow, supplying more oxygen and nutrients to the periphery. Cross-sectional studies report better subjective health status with an immersion bathing habit. This randomized controlled trial compared the effects on health of immersion bathing and shower bathing in 38 participants who received 2-week intervention of immersion bathing in warm water (40°C) for 10 min (bathing intervention) followed by 2-week shower bathing without immersion (showering intervention) or vice versa (n = 19 each group). Visual analog scale scores were significantly better for fatigue, stress, pain, and smile and tended to be better for self-reported heath and skin condition after bathing intervention than after showering intervention. The SF-8 Health Survey showed significantly better general health, mental health, role emotional, and social functioning scores. Profile of Mood State scores were lower for stress, tension-anxiety, anger-hostility, and depression-dejection. Immersion bathing, but not shower bathing, exerts hyperthermic action that induces increased blood flow and metabolic waste elimination, which may afford physical refreshment. Immersion bathing should improve both physical and emotional aspects of quality of life.

Association between having a hot spring water supply in the home and prevention of long-term care.

BACKGROUND AND OBJECTIVE: According to basic studies, hot spring use has positive effects on the mind and body. However, the association between habitual hot spring use and prevention of long-term care is unknown. Using long-term care insurance data for the residents of Atami City, Japan, who can choose to install hot spring water supply in their homes, this study aimed to determine the association between the installation of a hot spring water supply in the home and prevention of long-term care. METHODS: 1. STUDY DESIGN: case-control study 2. SUBJECTS: 2719 residents (754 men, 1965 women) of Atami City, Shizuoka Prefecture, Japan, who received long-term care insurance and were certified as "Needing Support" or "Needing Long-Term Care" as of March 2017. 3. Survey methods: Information on long-term care insurance certification was linked to subjects' care level dating back to their initial certification. Also, the installation (or lack thereof) of hot spring water supply in each subject's home was linked to information on Atami household water use as of March 2017. 4. Analysis methods: The age distribution of the subjects was determined. Initial care status and care status as of March 2017 were then compared for the 2194 subjects who received long-term care certification at least twice. These subjects were classified into two groups: those whose care level had not changed or had improved (no change/improvement group) and those whose care level had worsened (worsening group). Subjects were then compared by sex and initial care level in terms of hot spring installation and percentages of no change/improvement or worsening of care level; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the chi-square test. Lastly, the same analysis was performed for all subjects grouped together, and ORs and 95% CIs were calculated using the Mantel-Haenszel test. RESULTS: Hot springs were installed in the homes of 2359 subjects overall (86.8%). The no change/improvement group and the worsening group comprised 1192 and 1002 subjects, respectively. Overall, improvement or no change in care level was observed in 1050 subjects (55.2%) in the hot spring group and 142 subjects in the no hot spring group (48.5%). Sex-adjusted OR (95% CI) was 1.311 (1.025-1.677, p = 0.036), which represented a significant association. Having a hot spring water supply in the home may be associated with preventing worsening of care level. CONCLUSION: Having a hot spring water supply in the home may be associated with preventing worsening of care level.

The Consumption of Bicarbonate-Rich Mineral Water Improves Glycemic Control.

Hot spring water and natural mineral water have been therapeutically used to prevent or improve various diseases. Specifically, consumption of bicarbonate-rich mineral water (BMW) has been reported to prevent or improve type 2 diabetes (T2D) in humans. However, the molecular mechanisms of the beneficial effects behind mineral water consumption remain unclear. To elucidate the molecular level effects of BMW consumption on glycemic control, blood metabolome analysis and fecal microbiome analysis were applied to the BMW consumption test. During the study, 19 healthy volunteers drank 500 mL of commercially available tap water (TW) or BMW daily. TW consumption periods and BMW consumption periods lasted for a week each and this cycle was repeated twice. Biochemical tests indicated that serum glycoalbumin levels, one of the indexes of glycemic controls, decreased significantly after BMW consumption. Metabolome analysis of blood samples revealed that 19 metabolites including glycolysis-related metabolites and 3 amino acids were significantly different between TW and BMW consumption periods. Additionally, microbiome analysis demonstrated that composition of lean-inducible bacteria was increased after BMW consumption. Our results suggested that consumption of BMW has the possible potential to prevent and/or improve T2D through the alterations of host metabolism and gut microbiota composition.

Simple non-ion-paired high-performance liquid chromatographic method for simultaneous quantitation of carboxylate and lactone forms of 14 new camptothecin derivatives.

SN-38 (7-ethyl-10-hydroxycamptothecin) is an active metabolite derived from the semi-synthetic compound camptothecin (CPT) named Irinotecan (CPT-11). The antitumor activity of SN-38 is 1000-fold more potent than the parent CPT-11. Fourteen new derivatives of camptothecin have recently been developed by Yakult Honsha (Tokyo, Japan). Here we describe a simple and cost-effective high-performance liquid chromatography (HPLC) method without an ion-pairing agent, which allows the simultaneous determination of both lactone and carboxylate forms of SN-38 and other camptothecin derivatives. A weak linear relationship between the HPLC retention factors (ln k') and the cellular concentrations of these compounds was observed. These results suggest that low-polarity compounds easily accumulate in cancer cells and may circumvent drug resistance. The HPLC analysis herein described is expected to greatly assist in derivative synthesis and chemical modification of camptothecin-based antitumor drugs.

[Incidence rates for accidents associated with bathing services for the aged in Japan].

OBJECTIVES: To reveal incidence rates for accidents with bathing services for the aged in Japan. DESIGN: A postal questionnaire survey. PARTICIPANTS: Of 444 councils providing bathing services, we sent a postal questionnaire to 102 which had experienced accidents. MEASUREMENTS: Timing of the start of provision of bathing services, the total number of bathing services in 2000, and the number of accidents due to bathing services during the last five years in both home-visiting and facility bathing services. ANALYSES: In addition we estimated the total number of bathing services per one council for five years to yield the incidence of accidents per 10,000 bathings for the 444. Finally we estimated the total number of accidents due to bathing services in Japan. RESULT: Replies were received from 95 (93%) councils. The total number of bathings per council over five years was 4245.0 +/- 4637.7 for home-visits, and 22,235.3 +/- 37,259.4 in facilities. The incidence rates for accidents per 10,000 bathings in 95 councils which experienced accidents were 1.33 and 0.28, respectively. The rates for all 444 councils were 0.204 and 0.067, and the total numbers of accidents due to bathing services were estimated to be 63.1 in home-visits and 149.1 in facilities throughout Japan. CONCLUSION: These results indicated that providers' attention should be drawn to the higher incidence of accidents with home-visit than with facility bathing services.

Assessing the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy checklist (SPAC).

The purpose of this study was to assess the quality of study reports on spa therapy based on randomized controlled trials by the spa therapy and balneotherapy checklist (SPAC), and to show the relationship between SPAC score and the characteristics of publication. We searched the following databases from 1990 up to September 30, 2013: MEDLINE via PubMed, CINAHL, Web of Science, Ichushi Web, Global Health Library, the Western Pacific Region Index Medicus, PsycINFO, and the Cochrane Database of Systematic Reviews. We used the SPAC to assess the quality of reports on spa therapy and balneotherapy trials (SPAC) that was developed using the Delphi consensus method. Fifty-one studies met all inclusion criteria. Forty studies (78%) were about "Diseases of the musculoskeletal system and connective)". The total SPAC score (full-mark; 19 pts) was 10.8 ± 2.3 pts (mean ± SD). The items for which a description was lacking (very poor; <50%) in many studies were as follows: "locations of spa facility where the data were collected"; "pH"; "scale of bathtub"; "presence of other facility and exposure than bathing (sauna, steam bath, etc.)"; "qualification and experience of care provider"; "Instructions about daily life" and "adherence". We clarified that there was no relationship between the publish period, languages, and the impact factor (IF) for the SPAC score. In order to prevent flawed description, SPAC could provide indispensable information for researchers who are going to design a research protocol according to each disease.

The effects of bathing in hot springs on the absorption of green tea catechin: a pilot study.

Japan is a major tea producing country, and green tea is known for its health benefits which are believed to be due to catechins. However, difficulties in maintaining an adequate amount of catechins in the blood have been reported. Another important health-promoting activity among the Japanese is bathing in hot springs. This pilot study examined whether the combined effects of green tea consumption and hot spring bathing improved absorption of green tea catechins. The study, with a comparative within-subject design involving two different intervention trials--green tea consumption with hot spring bathing and only green tea consumption--was conducted on 2 separate days. Plasma levels of catechin; (-)-epigallocatechin-3-O-gallate (EGCG) were analyzed from four volunteers. Plasma EGCG concentration was found to be higher for the combined trial of green tea consumption and hot spring bathing.