This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.

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.

  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 among the Japanese. In our previous study, we investigated the frequency of bathing, the utilization of onsen facilities, and the consumption of green tea among the Japanese and found that these activities improved subjective health to a similar degree as balanced diet, exercise, no tobacco use, and quality sleep. In the present study, to ascertain healthy activities that should be encouraged throughout the year, we included survey items about seasonal variations in taking baths, taking showers, and utilizing onsen facilities, as well as investigated the difference between consumption of brewed green tea and of canned and bottled green tea. A cross-sectional questionnaire survey was conducted of 6,000 residents in Shizuoka prefecture aged ≥20 years in 2012. Using unconditional logistic models, odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for several factors that were considered to affect self-rated health (SRH; subjective health, sufficient sleep and rest, and subjective happiness). This time, in a more detailed investigation of bathing habits, onsen utilization, and green tea consumption, we found that daily bathing all year round (subjective health: OR=1.27, 95%CI 1.05-1.52; p=0.012, sufficient sleep and rest: OR=1.41, 95%CI 1.13-1.77; p=0.003, subjective happiness: OR=1.35, 95%CI=1.15-1.58; p0.021), and daily consumption of at least 500 mL of brewed green tea (subjective health: OR=1.24, 95%CI 1.01-1.53; p=0.039) are health-improving habits that should be proactively encouraged in daily living. We believe that the inclusion of a formal recommendation for daily green tea consumption and daily bathing and the establishment of reference values for these habits in the Health Promotion Policy will foster health and longevity in Japanese citizens.

Purpose: Tsukioka Onsen is the prominent hot spring which contains the largest amounts of sulfur in Japan. The purpose of this study is to clarify the benefits of bathing in Tsukioka Onsen by comparison between the bathing in Tsukioka hot spring and with natural water. Methods: Subjects were 20 females aged from 30 to 60 y.o. On 21th of November, we applied them to bathe in Tsukioka hot spring for 10 minutes (42 celcius) and to bathe in natural water for 10 minutes (42 celcius) using cross-over methods. The interval of the two way bathing was 2 hours. We conducted a questionnaire survey using visual analog scale in which participants answered their subjective health and the sensory evaluation of skin with hot water. Statistical analysis was performed using paired t-test. This research was approved by ethical committee of the Japan health & research institute. Results: Warming effect of full body, blood circulation, stiff shoulder and back pain were all improved after bathing either with hot spring and natural water. The effects were particularly stronger with hot spring than natural water. Recovery from fatigue, sense of relaxation, sense of refresh, most feeling of skin, refreshing touch of skin were improved only after bathing with hot spring.   Regarding to sensory evaluation of skin, smooth feeling and moist feeling of skin were significantly notified predominantly with hot spring not with natural water. Conclusion: This study showed that bathing in Tsukioka Onsen may cause thermal, cleaning, and moisture effects more than the one with natural water. We think that the alkalinity and the rich containing of chloride in hot water in Tukioka Onsen may contribute to these effects. We also suggested that one reason for these effects is that the large amounts of containing sulfur in Tukioka hot spring penetrated through skin may cause particular dilation of blood vessels in addition to the thermal effect of hot water.

Purpose  The effects of 10 min bathing at 41°C and 200 m/1.2min running inducing similar tachycardic response were examined comparatively on cardiovascular functions, blood gas and tissue metabolism, and peripheral blood compositions. Subjects and Methods  The subjects examined were 13 healthy males (28.7±3.6 yrs). They kept rest for 30min before bathing and running study and measurements of blood pressure (BP), heart rate (HR), sublingual temperature and skin blood flow and a indwellng catheter for blood sampling in cubital vein were performed. The subjects had 41°C bathing for 10 min and 200 m running/1.2 min (10km/hr) separately which induced the increase in heart rate by 30bpm in preliminary study. Measurements and blood sampling were done just after the loading (bathing or running) and 15min after the loading. Results and Discussion  The increase in HR just after bathing and running were nearly the same level, 27 and 25 bpm, respectively. The increase in systolic BP after running was greater than that after bathing, and diastolic BP was significantly reduced after bathing from resting level. Sublingual temperature and skin blood flow were increased only after bathing suggesting the marked thermal vasodilation.  After bathing, venous pO2 was significantly increased and pCO2 was significantly decreased, and there were no significant changes in lactate and pyruvate level. On the contrary, after 200 m running, venous pO2 was decreased and pCO2 was increased, and blood lactate, pyruvate and P/L ratio were significantly increased. These changes show that bathing provides tissue full oxygenation and washout of CO2 by increased blood supply without metabolic activation. After running, increased glycolysis in muscle and delayed oxidation by TCA cycle were suggested.  As the increase in WBC after bathing (+6%) and exercise (+22%) subsided very shortly., these changes might be explained by mixing perivascular flow enriched with leucocytes and central flow enriched with plasma due to increased circulation. Previous reports on the change of lymphocyte subsets after bathing and exercise should be examined from this viewpoint. The role of plasma concentration estimated from the changes in RBC and plasma protein was relatively low, around 2% by bathing and 4% by running. Conclusion  Health promotion by bathing seems to be conducted through sufficient O2 supply and washout of CO2 by thermal vasodilation without metabolic activation. Health promotion by exercise is induced by strong activation of cardiovascular and muscle metabolic function. Combination of passive effects by bathing and active exercise will be favorable for balanced health promotion.

Objectives: 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. Methods: 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, Psyc INFO, 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. Results: 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; 19pts) was 10.8±2.3pts (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. Conclusion: 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.

Purpose: Our previous study compared the characteristics of middle-aged persons who regularly take hot bathtub baths with those who do not and found taking hot bathtub baths helped to have good sleep and increase self-rated health. However, few studies have focused on this habit among young people. This study therefore compared the characteristics of young persons who regularly take hot bathtub baths with those who do not and clarify the potential effects of habitual bathtub bathing on their health. Methods: In this cross-sectional study, a self-reported questionnaire on bathtub bathing habits and general health and lifestyle was distributed to 483 university students between May and June 2013. Respondents were divided into two groups: those who took 3 or more bathtub baths per week (high-frequency group) and those who took 2 or fewer bathtub baths per week (low-frequency group). Differences between the groups were determined for sex, age, living with or apart from one’s family, quality of sleep, sense of fatigue, and self-rated health. Prior to conducting the study, the study protocol was approved by the Institutional Review Board of Daito Bunka University. Results: We obtained 394 responses (response rate: 81.6%) and analyzed 376 valid responses. Those who answered the question on bathtub bathing habits were divided into a high-frequency group (176 persons, 47%) and a low-frequency group (200 persons, 53%). The high-frequency group (52% men, 43% women, 5% sex was unknown) had a slightly greater proportion of men than in the low-frequency group (p=0.07). The two bathing frequency groups did not significantly differ by age group(p=0.43), and the age distribution in the high-frequency group age was 51% among 18 year olds, 45% among 19 year olds, 39% among 20 year olds, 48% among 21 year olds, and 61% among 22 year olds and older. Significantly more of the high-frequency group lived with their family (70% versus 23% living alone) than the low-frequency group (p<0.001). In terms of quality of sleep, 62% of the high-frequency group and 60% of the low-frequency group reported having good sleep (p=0.72). For sense of fatigue, 27% of the high-frequency group and 23% of the low-frequency group reported they did not experience fatigue (p=0.36), and for self-rated health, 81% of the high frequency group and 76% of the low-frequency group reported they were healthy (p=0.30). While there were no significant differences between the two groups, the findings suggest that those in the high-frequency group experienced good health. Results of logistic regression analysis adjusted for living with or apart from family showed the following odds ratios (95% confidence intervals) in the high-frequency group: good quality of sleep 1.02 (0.63-1.66), no fatigue 1.37 (0.76-2.46), and self-rated health 1.61 (0.90-2.89). Conclusion: Among university students in this study, men and persons living with their families were highly likely to take hot bathtub baths regularly. While there were no significant differences between the high and low frequency bathers, taking hot bathtub baths may marginally help to reduce fatigue and increase self-rated health. Competing interests: The authors declare no conflicts of interest.