Background: In recent years, Finnish sauna bathing has been reported to have beneficial health effects, such as reducing the risk of hypertension and dementia. Although tub bathing in Japan, which is used daily by the Japanese, differs from sauna bathing, there are a few reports on its potential effects in reducing the risk of cardiovascular disease and depressive symptoms, but no reports on dementia. Therefore, we aimed to investigate the association between bathing and incident dementia in Japanese community-dwelling older people using large longitudinal data.  Methods and Results: We used data from the Japan Gerontological Evaluation Study (JAGES), which included community-dwelling older people aged ≥65 years who were not certified for long-term care. The baseline survey was conducted in 2010, and the onset of dementia was assessed using records from Japan’s long-term care insurance system. After excluding respondents with missing data on bathing frequency in summer and winter separately, a total of 7,509 individuals were analysed for summer and 7,590 for winter. Bathing frequency was divided into two groups: low frequency (0-6 times/week) and high frequency (≥7 times/week). To examine the association between bathing frequency and incident dementia, we performed survival analysis using the competing risk model and calculated sub hazard ratios (SHRs) and 95% confidence intervals (CIs). During 9 years of follow-up, 1,430 (17.2%) cases of dementia were identified in 8,317 individuals. In the crude model, the high-frequency bathing group showed a significantly lower risk of incident dementia, and this association remained significant after full adjustment, with SHRs of 0.74 (95% CI: 0.62-0.88) in summer and 0.82 (95% CI: 0.70-0.97) in winter.  Conclusions: High-frequency bathing was associated with a lower risk of incident dementia among Japanese community-dwelling older adults. This finding suggests that tub bathing, one of the lifestyle habits of older people in Japan, may contribute to preventing dementia.

Objective: This retrospective study was conducted to investigate whether medical students have ever bandaged patients' limbs, whether they feel confident in their ability to bandage, and whether their bandaging skills are adequate.Methods: The study included consecutive fifth-year medical students who had not been taught bandaging knowledge and skills. In total, 232 students (163 men, 69 women) participated in the study. Prior to the practical session, the students' experiences and confidence in bandaging were assessed. During the practical, an evaluator assessed the students' bandaging skills, determining the correct application of bandages and assigned a numerical score. Correlations were analyzed using the Chi-square test.Results: Of the medical students in this study, 60% had not bandaged a limb by their fifth year, and 91% lacked confidence in their bandaging ability. Only 32% of students could correctly apply a bandage with a perfect score. No significant relationships were identified between experience and bandaging skill (P = 0.64) or confidence and bandaging skill (P = 0.36).Conclusions: Bandages must be applied perfectly to prevent loosening and contamination of the wound. Nevertheless, most medical students had not bandaged a limb, lacked confidence in their bandaging abilities, and were unable to correctly apply a bandage. It is imperative that medical educators teach bandaging skills to medical students and provide ample opportunities for practice.

  Background: The traditional Japanese style of soaking in a hot bath is a lifestyle custom for many citizens, no study had ever investigated the association between bathing as a lifestyle practice and the onset of long-term depression. Through a large-scale six-year longitudinal study, we aimed to determine whether tub bathing as a lifestyle custom plays a role in preventing the onset of long-term depression.  Methods: Of 11,882 individuals who responded to surveys conducted in 2010 and 2016 as part of the Japan Gerontological Evaluation Study (the JAGES) project, we analyzed 6,452 and 6,465 individuals for whom information was available regarding summer bathing frequency and winter bathing frequency, respectively; all of these individuals were independent, had a Geriatric Depression Scale (hereafter, “GDS”) score of ≤4, and did not suffer from depression. The cohort study involved dividing participants into a group of those who bathed 0-6 times a week and a group of those who bathed ≥7 times a week and determining the percentages of individuals who developed depression based on their GDS scores six years later. Multiple logistic regression analysis was performed to determine odds ratios for the association between depression onset and tub bathing.   Results: For individuals who tub bathed ≥7 times a week, the odds ratios for depression onset versus individuals who bathed 0-6 times a week in summer and winter were 0.84 (95% confidence interval, 0.64-1.10) and 0.76 (95% confidence interval, 0.59-0.98), respectively. Tub bathing ≥7 times a week in winter significantly reduced the risk of depression onset.  Conclusions: New-onset depression was shown to be infrequent in older adults who bathe in a tub frequently. Tub bathing was suggested to potentially contribute to the prevention of depression in the elderly.

  Background: The traditional Japanese style of soaking in a hot bath is a lifestyle custom for many citizens, no study had ever investigated the association between bathing as a lifestyle practice and the onset of long-term depression. Through a large-scale six-year longitudinal study, we aimed to determine whether tub bathing as a lifestyle custom plays a role in preventing the onset of long-term depression.  Methods: Of 11,882 individuals who responded to surveys conducted in 2010 and 2016 as part of the Japan Gerontological Evaluation Study (the JAGES) project, we analyzed 6,452 and 6,465 individuals for whom information was available regarding summer bathing frequency and winter bathing frequency, respectively; all of these individuals were independent, had a Geriatric Depression Scale (hereafter, “GDS”) score of ≤4, and did not suffer from depression. The cohort study involved dividing participants into a group of those who bathed 0-6 times a week and a group of those who bathed ≥7 times a week and determining the percentages of individuals who developed depression based on their GDS scores six years later. Multiple logistic regression analysis was performed to determine odds ratios for the association between depression onset and tub bathing.   Results: For individuals who tub bathed ≥7 times a week, the odds ratios for depression onset versus individuals who bathed 0-6 times a week in summer and winter were 0.84 (95% confidence interval, 0.64-1.10) and 0.76 (95% confidence interval, 0.59-0.98), respectively. Tub bathing ≥7 times a week in winter significantly reduced the risk of depression onset.  Conclusions: New-onset depression was shown to be infrequent in older adults who bathe in a tub frequently. Tub bathing was suggested to potentially contribute to the prevention of depression in the elderly.

  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.

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.