Background: Although problem–based learning （PBL） tutorials have widely been used in many medical schools, they are rarely used to enhance the effectiveness of clinical clerkships.
Methods: We used a questionnaire survey to evaluate the effectiveness of PBL tutorials during the clinical clerkships of 5th–year medical students.
Results: Of the 91 students, 90％ answered that PBL tutorials during clinical clerkships were considerably useful, and 94％ favored using PBL tutorials during clinical clerkships. All responses to the open–ended question regarding the usefulness of PBL tutorials stated that PBL tutorials were more useful during clinical clerkships than in the 2nd to 4th years. Many students felt that PBL tutorials helped them understand the processes of clinical reasoning and decision–making.
Conclusion: PBL tutorials increase the effectiveness of clinical clerkships, and, at the same time, the experiences of clinical clerkships increase the effectiveness of PBL tutorials.

Purpose: Bathing habits are said to be affected by the country of residence. We investigated and compared bathing habits between Japanese living in Kyoto and Japanese Americans living in Los Angeles.

Methods: 488 subjects living in Kyoto (Japanese) and 539 subjects living in Los Angeles (Japanese Americans) were enrolled. The survey items for bathing habits were as follows: frequency (times per week) and time (morning, afternoon, evening) of taking baths and showers, other styles of bathing, and bathing duration (both baths and showers). We performed a simple tabulation and cross tabulation, calculated 95% confidential intervals by simple tabulation, and compared the results using chi-square analysis. The survey was conducted in Los Angeles in October 2010 and in Kyoto in December 2013.

Results: The percentage of subjects who took baths was 92.8% for Japanese and 56.0% for Japanese Americans. The frequency of taking a bath was 36.8 points higher for Japanese compared with Japanese Americans. The percentage of subjects who took showers was 71.7% for Japanese and 82.6% for Japanese Americans. The frequency of taking a shower was 10.9 points higher for Japanese Americans compared with Japanese. The most common response for frequency of bathing was “every day”, followed by “every other day” in both groups. The most common response for the time of taking a bath was “evening” in both groups. Among Japanese Americans, 21.8% took baths in the “morning”. Most Japanese indicated they took a shower “less than once a week” (48.0%), whereas most Japanese Americans took a shower “every day” (78%). The timing of taking a shower was in the “evening” for most Japanese, but in the “morning” or “evening” for most Japanese Americans. The most common response for bathing duration (both baths and showers) was “26-30 min” among Japanese and “6-10 min” among Japanese Americans.

Discussion: For Japanese Americans, the purpose of bathing was suggested to be cleaning the body since their main style of bathing was taking showers of a short duration in the morning or evening. On the other hand, for Japanese, the purpose of bathing was thought to be cleaning and healing the body, but also maintaining health since their main style of bathing was taking baths of a long duration in the evening. We speculate that the country of residence affects bathing habits and that there are differences among people of the same race living in different countries.

Conclusion: Bathing habits such as bathing style, the time of bathing and bathing duration were different between Japanese and Japanese Americans.

Objectives: Many patients with chronic pain and fibromyalgia (FM) consult health care clinics continually, and move from hospital to hospital without gaining pain relief. In some patients, prolonged refractory pain affects their daily life and social function despite various treatments. The purpose of this study was to clarify the effects of Waon therapy in patients with chronic pain and FM. Patients and Methods: Study A: 46 patients with chronic pain were assigned to Waon therapy group (n = 22) or non-Waon therapy group (n = 24). All patients were admitted to our hospital for 5 weeks. In non-Waon therapy group, cognitive behavior therapy (CBT), rehabilitation, and exercise therapy were performed during hospitalization. Waon therapy was started 2 weeks after admission in addition to CBT, rehabilitation, and exercise therapy. And the therapy was performed for 4 weeks. Pain was evaluated by the visual analog scale (VAS). Pain behavior was assessed based on the 11 items and the number per day was counted. Anger score was evaluated using the mentral complaints in the Cornell Medical Index. The degree of satisfaction with treatment was evaluated at discharge. Study B: 12 patients who fulfilled the FM criteria of the American College of Rheumatology. All patients received 20 sessions of Waon Therapy at our outpatients clinic. The VAS pain scale and the Fibromyalgia Impact Questionnaire (FIQ), Profile of Mood State (POMS) were evaluated before and after 10 and 20 sessions of Waon Therapy. Results: Study A: The differences in number of pain behavior and anger scores before and after treatment were significantly larger in Waon therapy group than those in non-Waon therapy group. The treatment was rated as ‘satisfactory’ or ‘very satisfactory’ by 55% in non-Waon-therapy group and 82% in Waon Therapy group. Study B: The VAS pain scores and FIQ scores were improved after the 10 and 20 sessions of Waon therapy. In the POMS, depression and anger, anxiety, confusion scales were sigificantly decresed and vigor score was elevated. Conclusion: Waon therapy may be a promising method for treatment of chronic pain and fibromyalgia.

  Pregnancy has been removed from the list of contraindications for hot spring bathing. Therefore, The Japanese Society of Balneology, Climatology and Physical Medicine has considered that it is necessary to conduct a joint research on the safety of hot spring bathing for pregnant women, publish the results extensively, and enlighten the public about this matter. Considering that only a small number of reports have been published in Japan about the safety of hot spring bathing for pregnant women, the Society has decided to study this subject.   Expectant and nursing mothers living in hot spring towns, such as Beppu and Ibusuki City, have responded to questions about the period between the early stages of pregnancy and delivery via a self-administered questionnaire; The questions included: 1) age when the pregnancy ended, 2) number of previous deliveries, 3) details of hot spring bathing　habits (whether they bathed in hot springs on a daily basis, how often they bathed during the different [early, middle, and late] stages of pregnancy, and whether they used hot spring baths attached to their homes or hot spring facilities away from their homes), and 4) whether they had pregnancy complications such as miscarriages (excluding those occurring in the early stages of pregnancy), premature delivery, threatened premature delivery, or toxemia of pregnancy/pregnancy-induced hypertension (edema, hypertension).  Total 1,721 responses were collected (86% reply rate). The mean participant age was 30.8 years. Importantly, there were 643 (37.6%) primigravid and 1,078 (62.4%) parous women. Age and gravidity were not associated with pregnancy complications. In the early and middle stages of pregnancy, there were no significant differences in the incidence of pregnancy complications between individuals who bathed ≥ once per week [hot spring bath (+)] group and those who bathed < once per week [hot spring bath (−)] group. In the late stages of pregnancy, the number of pregnancy complications were fewer in the hot spring bath (+) group (20.3%) than that in the hot spring bath (−) group (25.9%) (p = 0.028). In addition, there were no significant differences in the pregnancy complications between hot spring bathing (+) and hot spring bath (−) groups in the early and middle stages of pregnancy even if we focused on the homecoming pregnant women. Whereas, in the late stages of pregnancy, the number of pregnancy complications were fewer in the hot spring bath (+) group (13.0%) compared with the hot spring bath (−) group (24.5%) (p = 0.028) in the homecoming pregnant women.  This study has confirmed that daily hot spring bathing during pregnancy does not increase the incidence of pregnancy complications. Furthermore, it can be stated that the removal of “pregnancy” from the contraindications of hot spring bathing was appropriate.