Background and objectives: Bathing services are available under long-term care insurance for the elderly. However, care workers have difficulty assessing safety for bathing in the absence of concrete criteria and guidelines. Currently, the pre-bathing health condition of care receivers is assessed mainly by blood pressure and body temperature measurements. This study aimed to identify the relationship of pre-bathing health condition assessed by blood pressure and body temperature measurements with illness and incidents related to bathing care.
Methods:
1. Design: A case-control study (prospective registry study).
2. Subjects: All registered service providers of long-term care (2,330 in total) offering at-home bathing support.
3. Methods: Cases were defined as community-dwelling residents who had a bathing care-related illness or incident. As controls, two care receivers for each service provider were randomly extracted from the collected data. The study period was 1 year, from June 2012 to May 2013. A simple comparative analysis between the two groups was conducted for age, sex, degree of independence in daily life of disabled elderly individuals (degree to which they were bedbound), degree of long-term care needed, modified Rankin Scale score, level of alertness, degree of independence in daily life of patients with dementia, blood pressure before bathing, and body temperature before bathing. Univariate and multivariate logistic regression analyses were performed, with illness and all incidents or illness and incidents excluding elevated body temperature and elevated or reduced blood pressure as objective variables, and other factors as explanatory variables. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.
Results: A total of 596 cases and 1,511 controls were analyzed. Simple comparative analysis revealed more care receivers had elevated body temperature before bathing in the case group than in the control group. Multivariate analysis with illness and incidents excluding elevated body temperature and blood pressure changes as objective variables showed significant relationships when systolic blood pressure was 160-179 mmHg (OR, 3.63; 95%CI, 1.39-9.50), diastolic blood pressure was 100-109 mmHg (OR, 14.71; 95%CI, 1.31-165.77), body temperature was 37.5-37.9°C(OR, 16.47; 95%CI, 3.30-82.40), and body temperature was ≥38.0°C (OR, 6.57; 95%CI, 1.40-30.81) before bathing.
Conclusion: High blood pressure (≥160/100 mmHg) and elevated body temperature (≥37.5°C) before bathing are possible risk factors of bathing-care-related illness and incidents.

To determine the need of guidelines for judgment of the bathing advisability for the aged in Councils of Social Welfare, we had a cross-sectional study in 1999.
A questionnaire survey by mail for Councils of Social Welfare which were extracted by systematic sampling (n=828, extraction rate was 25%) was conducted. The response rate was 83% and the proportion of respondents who answered the guidelines were necessary was 86% (n=642). Chi-square tests and logistic regressions analyses showed that bathing service in facility, existence of guidelines for judgment of the bathing advisability by body temperature, and respondents judging were independent factors associated with the need of guidelines for judgment on the bathing advisability in aged. Our results suggest the necessity to make guidelines for judgment of the bathing advisability in the aged.

To determine the background of aged people who need bathing assistance, we analyzed data of the Survey on Demand for Health and Welfare Services of Japan as of 1997. The survey covered 21, 723 persons aged 65 years or older, and 1, 193 caregivers who provide care to persons 65 years or older throughout Japan. The main parameters were aged people's sex, age, marital status, health condition, degree of bed rest, and needs of care in daily life; relation between caregivers and aged people; life with care giver; job; family composition; use of home care services; demand for home care services; caregivers' sex, age, health condition, and employment status; and demand for home care services. Subjects were divided into three groups, those who need bathing assistance, those who do not need bathing assistance, and those who do not need care in daily life, and the rate was shown for each item. The results indicated that the rate of those who need bathing assistance was higher among (1) aged people who were older, have poor health, and are in bed alweys or almost alweys, (2) aged people who needed care in daily life, used home care service, and required home care service, and (3) aged people whose caregivers required home care services.
Aged people who need bathing assistance are subject to frequent bathing accidents, so we need to pay attention to safe bathing service.

  The primary objective of this study was to collect evidence that individuals who use hot spring facilities and public baths have a low risk of being infected with COVID-19. The secondary objective was to comprehensively summarize the research issues that remain to be explored in the field of balneology considering results of previous research.  Literature databases used were CINHAL, Cochrane Library (Clinical Answer, Cochrane Protocol, Cochrane Review, Editorials, Special Collections, Trials), Ichushi Web (in Japanese), MEDLINE, and Web of Science Core Collection. For each database, we selected results from the time it was opened through July 26, 2021. When intervention studies and experimental were searched, the following modified PICOS was used the following: P (Participant: no restrictions on the presence or absence of illness), I (Intervention: normal breathing or intentional sneezing, coughing, conversation), C (Comparison: no restrictions), O (Outcome: markers that simulate the flow of indoor air, the dynamics of droplets, and droplets in bathrooms and dressing rooms), and S (Study design: including intervention studies and experiments without a control group). For observational studies, PECOS included: P (participants: unlimited with or without disease), E (Exposure: public bathing facility), C (comparison: unrestricted), and S (study design: cross-sectional study, cohort study, and case-control study).  For the primary objective, no studies met the eligibility criteria, and at the time of this study there was no evidence that the use of hot spring facilities or public baths presented a low risk of being infected with COVID-19. Regarding the secondary objective, there were 15 relevant studies. In the context of a society that is strongly influenced by COVID-19, our literature review identified four research issues: “A. Use of hot spring facilities and public baths has a low risk of COVID-19 infection”, “B. The quality of hot springs and the room temperature and water temperature of public baths make SARS-CoV-2 inactivate/attenuate”, “C. Hot spring facilities, public baths, bathing habits at home lead to prevention of COVID-19 and alleviation of symptoms”, “D. Bathing for survivors of COVID-19 is effective for various rehabilitation of patients”. Suitable research approaches for each issue would be required in order to grasp each evidence.

  The primary objective of this study was to collect evidence that individuals who use hot spring facilities and public baths have a low risk of being infected with COVID-19. The secondary objective was to comprehensively summarize the research issues that remain to be explored in the field of balneology considering results of previous research.  Literature databases used were CINHAL, Cochrane Library (Clinical Answer, Cochrane Protocol, Cochrane Review, Editorials, Special Collections, Trials), Ichushi Web (in Japanese), MEDLINE, and Web of Science Core Collection. For each database, we selected results from the time it was opened through July 26, 2021. When intervention studies and experimental were searched, the following modified PICOS was used the following: P (Participant: no restrictions on the presence or absence of illness), I (Intervention: normal breathing or intentional sneezing, coughing, conversation), C (Comparison: no restrictions), O (Outcome: markers that simulate the flow of indoor air, the dynamics of droplets, and droplets in bathrooms and dressing rooms), and S (Study design: including intervention studies and experiments without a control group). For observational studies, PECOS included: P (participants: unlimited with or without disease), E (Exposure: public bathing facility), C (comparison: unrestricted), and S (study design: cross-sectional study, cohort study, and case-control study).  For the primary objective, no studies met the eligibility criteria, and at the time of this study there was no evidence that the use of hot spring facilities or public baths presented a low risk of being infected with COVID-19. Regarding the secondary objective, there were 15 relevant studies. In the context of a society that is strongly influenced by COVID-19, our literature review identified four research issues: “A. Use of hot spring facilities and public baths has a low risk of COVID-19 infection”, “B. The quality of hot springs and the room temperature and water temperature of public baths make SARS-CoV-2 inactivate/attenuate”, “C. Hot spring facilities, public baths, bathing habits at home lead to prevention of COVID-19 and alleviation of symptoms”, “D. Bathing for survivors of COVID-19 is effective for various rehabilitation of patients”. Suitable research approaches for each issue would be required in order to grasp each evidence.

  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.

Among lots of lifestyle factors thought to be related to the Japanese health status, bathing in hot water, utilizing onsen (hot spring) facilities, and drinking green tea are very special in Japan. With this study we aimed to determine the contribution of these lifestyle factors to Japanese health condition estimated by self-rated health (SRH), sleep quality and rest, and stress level as the dependent variable. A cross-sectional questionnaire survey was conducted of 5,000 residents in Shizuoka prefecture aged≥20 years in 2011. Using unconditional logistic models, odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for several factors that were considered to affect SRH. The lifestyle habits of bathing in hot water every day, utilizing onsen facilities often, and drinking green tea a lot showed a strong association with good SRH. Bathing in hot water was also related to lower perceived stress. In conclusion, the promotion of daily bathing in hot water, utilizing onsen facilities often, consuming a lot of green tea examined in this study may help to enhance people’s own perception of their general health. It is possible that these lifestyle habits may contribute to good health status of the Japanese.