The purpose of this study was to examine how constitutions, blood profiles, knee and back pain, and the psychological state of middle-aged and elderly women were influenced by comprehensive health education that consisted of instructions in appropriate ways of bathing in hot springs and education on lifestyle and exercise.
Of the middle-aged and elderly female residents in village A in Nagano prefecture, 266 underwent health check-ups in August and September 2002. Fifty-six of these women voluntarily participated in this study, and were divided into an intervention and a control group randomly. Finally, the intervention group and control groups consisted of 22 and 26 subjects, respectively, who were considered suitable for study purposes.
The intervention group received comprehensive health education once a week for 3 months (total 11 times) between the latter part of September and the middle of December. For the comprehensive health education, subjects participated in hot spa bathing in a salt spring for 20 minutes in all (two 10-minute periods), and lifestyle education and exercise, including stretching, walking, light sports, dietary instruction, etc., during 60-minute sessions. After the series of comprehensive health education was completed, the following improvements were noted in the intervention group. As to blood profiles, the plasma level of uric acid significantly decreased from 4.4±1.1mg/dl to 4.1±1.1mg/dl (p<0.05) and the arterioloscerotic index decreased from 2.85±0.90 to 2.68±0.83 (p=0.07). The intensity of lumbago expressed on a visual analogue scale significantly decreased from 23.5±28.4% to 14.2±21.5% (p<0.01). The intensity of psychological tension decreased from 45.3±6.3 points to 43.2±6.0 points (p=0.06). The mean number of comprehensive health education sessions attended was 9.9±1.4 (range 7 to 11). The number of improvements implemented with regard to a healthy lifestyle significantly increased (p<0.05). Behavior of the subjects in the intervention group appeared to have changed towards a desirable lifestyle.
The results of this study show that even intermittent and brief health education combining “hot spa bathing and lifestyle education and exercise” is effective to maintain and improve health of middle-aged and elderly women.

The purpose of this study was to review several kinds of checklists and statements of studies in human subjects, and to examine reporting methods in order to improve the quality of studies concerning hot springs.
For randomized controlled trials (RCTs), “the CONSORT Statement” (Moher et al. JAMA 2001) consisting of 22 terms is the most well known checklist. In addition, different versions and new checklists have been developed depending upon the content of the studies (such as intervention methods) or field of the studies. There is also “the QUOROM Statement” (Moher et al. Lancet 1999) for a systematic review (SR) of RCTs, “the TREND Statement” (Jarlais et al. Am J Public Health 2004) for nonrandomized controlled trials, “the STROBE Statement” (Elm et al. Ann Inter Med 2007) for observational studies, and “the MOOSE Checklist” (Stroup et al. JAMA 2000) as a SR of observational studies. With regard to studies on hot springs, however, terms in the checklists and the statements described above are insufficient or inappropriate because of difficulties in performing such studies in a blinded manner, and the diversity of intervention methods, such as the quellen charakter.
Improvement of the quality of reports is important for validation of evidence. In order to improve the quality of assessments and reports of studies on hot springs, it may be necessary to develop a unique checklist based on the above-described statements and checklists.

This study attempted to clarify the effects of 3- and 6-month comprehensive health education programs based on hot spa bathing, lifestyle education and physical exercise on physique, psychological vigor, blood properties, pains in the knee and back, and mental and psychological aspects of women. We examined middle-aged and elderly women who were randomly divided into two groups and followed up until six months and one year later, respectively.
Spa programmers, an exercise instructor, and a dietician instructed subjects to one hour of life-style education and physical exercise (lecture on behavior modification, walking, rhythmic exercise, cooking practice, etc.) and one hour (including time for changing clothes and washing body) of a half bath (salt spring, temperature at 41.5) once a week. The program for the 3-month group (n=19) was repeated in the 6-month group (n=14).
The evaluation items were BMI, PWC75%HRmax (by a bicycle ergometer as aerobic capacity), blood properties (total cholesterol, HDL cholesterol, arteriolosclerotic index, uric acid, and HbAlc), profile of mood states, self-rating depression scale, subjective happiness, and pains in the knee and back.
Compared with pre-intervention data (26.3±3.6), the BMI decreased significantly (p<0.05) immediately after the intervention (25.7±3.5) and at the follow up six months later (25.7±3.3) in the group of 6-month intervention. In addition, the PWC75%HRmax, HbAlc, pains in the back, vigor, depression, and subjective happiness remained significantly improved (p<0.05), as measured at the 6-month follow-up. On the other hand, some of the items improved in the 3-month intervention group immediately after the intervention, but returned to nearly the same levels as those before intervention at the 1-year follow-up. Significant differences (p<0.05) were found in the PWC75%HRmax, HbAlc, and fatigue between the two groups, all of which were improved in the 6-month intervention group.
These results suggest that a low frequency, once-a-week intervention requires duration longer than three months to maintain the effects, and that the effects should be monitored over years for a correct assessment.

The purpose of this study was to clarify the relationship between frequency of bathing in a spa and at home and the characteristics of the body, blood, and lifestyle of white-collar and blue-collar male employees.
To recruit subjects, two baseline data for randomized controlled trials in two places in Shimane Prefecture and in Nagano Prefecture were used. In the two-month period between August and September 2006, 43 of 311 white-collar male employees aged between 30 and 57 years in the Unnan municipal office volunteered to participate in this study. Similarly, 44 blue-collar workers in Nagano Prefecture volunteered to be involved in this study as a result of an appeal for volunteers in local newspapers and public information journals published by large local enterprises from September through November 2006. A total of 87 men were subjects of this study. Items evaluated in this study with respect to physique included height, weight, body mass index, waist circumference, hip circumference, and percent of body fat. With respect to strength, they were grip strength, abdominal strength, back strength, and anteflexion. With respect to characteristics of the blood, they were serum glucose, hemoglobin A1c, fructosamine, lactic acid, total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, free fatty acid, GOT, GPT, γ-GTP, cholinesterase, natural killer cell activity, T cell, B cell, CD4+, CD8+, CD4/8 and uric acid. With respect to mood, Profile of Mood States was evaluated. With respect to lifestyle, the frequency of monthly bathing in a spa and at home was evaluated.
No significant correlation was revealed between frequency of monthly spa bathing and the health indices in the white and blue-collar male workers. The items that were significantly correlated (p<0.05) with frequency of monthly bathing at home were GOT (positive), CD8+ (positive), and mental stress (negative).
In this study, frequency of monthly spa bathing was found to have no significant correlation with the health indices.

 The purpose of this study was to systematically review non-randomized controlled trials of balneotherapy effects on locomotorium diseases in order to assess their quality and organize the evidence.
 We searched the databases of PubMed, CINAHL, Web of Science, JDream ll, and lchushi-Web forpapers published from 1990 to December 2, 2008. Eligible studies were non-randomized controlled trials in which balneotherapy exclusive of underwater exercise was the primary intervention. There was no limitation on the language in which the paper was written.
 We found only 4 papers (2 in English, 1 in Croatian, and 1 in Japanese) that fulfilled the eligibility criteria. These papers differed in the type of diseases studied, so a meta-analysis could not be applied. Their individual results showed that hot springs treatment in combination with a comprehensive fitness class was more effective than hot springs treatment alone, and that balneotherapy had therapeutic effects on arthrosis deformans, psoriatic arthritis, and lumbago. However, it was difficult to accurately interpret the effects because these papers were deficient in providing descriptions of important details of the studies.
 To improve the quality of future investigations performed with non-randomized controlled trials, we suggest that investigators design a study based on various checklists, implement interventions, conduct evaluations, finally write papers summarizing their findings.

 The purpose of this study was to systemically review cohort studies of the preventive effects on locomotorium diseases in order to collectively evaluate the evidence.
 We searched the databases of PubMed, CINAHL, and lchushi-Web for papers published from1990 to September 17, 2009. The search was not limited by the language in which the paper was written.
 We found only one article (in Japanese) that fulfilled the eligibility criteria. Results in this article showed that bone fractures were significantly lower in the group with two times or more utilization of the hot spa bathing per year compared to the group with one time or less utilization per year, even after adjusting for the confounding effects of exercise habits and WHO-QOL. However, a metaanalysis could not be applied.
 We propose that it is necessary to conduct more cohort studies in which researchers choose suitable outcome measurements that assess long term effects.

In this study, we investigated whether subjects with a Lower Maximum Step Length (MSL) Percentage (LMP) display unstable locomotion while negotiating an obstacle. Data were collected using a three-dimensional motion analysis system. The toe-obstacle clearance of the leading limb was monitored in 10 young adults while stepping over three height obstacles from 30%, 40% and 50% of MSL. The vertical clearance at the time of the obstacle crossing decreased systematically with more complicated experimental set up. In particular, subjects with LMP showed smaller clearances than subjects with a Higher Maximum step length Percentage (HMP). Furthermore, a significant correlation was observed between the toe-obstacle clearance and MSL. The mean of variance value of toe-obstacle clearance of the leading limb differed between the subjects with LMP and those with HMP. Our findings help to explain the relation of MSL and gait adaption ability to negotiate obstacles safely during obstacles crossing.

The purpose of this study was to investigate the identification of distinct characteristics of postural control during transition from a dynamic into a static state in young and older adults. We tested 8 healthy elderly (mean age of 67 yr±0.8) and 8 healthy young (mean age of 23 yr±1.2) adult subjects. After the consent session, all trial participants gave written informed consent if they agreed voluntarily to participate. The subject transitioned from a dynamic state into a static state on the force platform during a step maximally. Center of pressure (COP) from the force platform were recorded during 15s from both feet on the force plat with a sampling frequency of 100 Hz.The anterior-posterior (A-P) and medial-lateral (M-L) direction mean of COP of older adult subjects produced different postural sway and presented significant difference on the distributed value of COP in the quiet standing after the dynamic task, in comparison to the young adult subjects. A-P direction and M-L direction mean of COP was significant difference during the seconds from 0 to 2 (p＜0.05), and 1.5 to 2.5 (p＜0.05), respectively, between young and old subjects. The difference in the mean distance of COP and distributed value of COP between younger and older subjects were revealed by this study. These findings indicate that the development of a simple, non-stressful technique to analyze postural control in older adults is highly useful.

We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40℃, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
Aneurysm ; Arteries ; Bacterial Infections ; Child, Preschool ; Coronary Vessels ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Erythema Nodosum ; Erythema ; Exanthema ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Lower Extremity ; Lymphatic Diseases ; Masks ; Mass Screening ; Mucocutaneous Lymph Node Syndrome ; Neck ; Oropharynx ; Salmonella ; Skin ; Subcutaneous Tissue

 Objective: The objectives of this study were to compare medical expenses for the aged, the index of inter-government differences, nursing care expenses, the percentage of advanced nursing care, life expectancy, and the spa-related variables among rural governments in the same class based on the national criteria, in order to clarify the factors that affect nursing care and medical expenses.  Methods: The Ministry of National Affairs and Communications classifies rural governments into 35 categories based on their population and industry. The subjects of this study were from the category III-0 (population between 100,000 and 150,000, percentage of tertiary industry below 55%) and 11 towns and villages met the eligibility criteria. We used statistical data open to the public in 2007, and calculated the correlation coefficients and multiple regression coefficients using medical expenses for the aged and nursing-care expenses as dependent variable.  Results: Variables that had a significant correlation with medical expenses for the aged were percentage of medical expenses for the aged (r=-0.61, p<0.05), hospital expenses (r=0.88, p<0.05), the index of inter-government differences (r=0.75, p<0.05), and number (per 1,000 people) of spa hotels (r=-0.61, p<0.05). Variables that had significant correlation with nursing care expenses were percentage of people insured (r=-0.65, p<0.05), percentage of people insured who resigned from job(r=0.66, p<0.05), the average life span (r=0.82,p<0.05). Variables that had a significant effect on medical expenses for the aged were hospital expenses (β=0.618, p<0.05), the index of inter-government differences (β=0.334, p<0.05), and (per 1,000 people) of spa hotels (β=-0.210, NS). There was no spa-related variable that had a significant correlation with nursing care expenses, and we did not conduct multiple regression analysis for them.  Conclusion: Although the correlations with the indices for spa among medical expenses for the aged and nursing care expenses were very low, the necessity of clarifying the numerical value of people who used spa actually was shown.