Objectives: Approximately 17% of Japanese women have hemoglobin concentrations less than 12 g/dL. Therefore, anemia prevention and early intervention are crucial public health issues in Japan. This study aimed to identify the symptoms and characteristics of anemic individuals in the general adult population by comparing survey responses of individuals with anemia and without anemia visiting blood donation centers.Materials and Methods: This cross-sectional study used self-administered questionnaires. Individuals who visited two Japanese Red Cross Society blood donation centers in Fukushima Prefecture, Japan were included. Hemoglobin levels were measured at blood donation, and the levels of 13 g/dL for men and 12 g/dL for women were defined as anemia.Results: Of the 857 individuals analyzed, 530 were men and 327 were women, of whom 19 (3.6%) and 12 (3.7%) had low hemoglobin levels, respectively. Logistic regression analysis was performed in men, and the results showed that “lightheadedness” (odds ratio [OR]=8.4) and “depressive symptoms” (OR=3.6) were significantly associated with hemoglobin levels. None of the evaluated items were significantly associated with hemoglobin levels in women.Conclusion: Among healthy Japanese men, those who exhibit lightheadedness and depressive symptoms have an increased risk of anemia. Lightheadedness and depressive symptoms may be indicative of undiagnosed anemia in men, which necessitates greater clinical attention.

Objective: To clarify challenges and strategies to execute pharmaceutical care by community pharmacists and obtain pragmatic implications for further improvement. Design: Cross-sectional study.. Methods: We conducted a nationwide internet-based questionnaire survey about pharmaceutical care by the Japanese community pharmacists in June and July 2016. Using text data of 161 respondents, we investigated their challenges and strategies in implementing pharmaceutical care. The text data were reviewed and determined for categorization through stepwise process and reconciliation between reviewers. Results: Fourteen categories were retrieved and integrated into 4 domains (pharmacists, patients, other medical professionals, and environment) from 2 dimensions (challenges and strategies). In the challenge dimension (total n＝142), communication capability (n＝26), participation in medical team (n＝17), patients’ understanding of pharmacists’ work (n＝14), lack of timeand staff (n＝14),patient- and people-centered viewpoint (n＝13). Whilein thestrategy dimension (total n＝72), communication capability (n＝21),lack of patients’ medical information (n＝18), patient- and people-centered viewpoint (n＝11), lack of timeand staff (n＝9), and self development (n＝5). As strategies for the communication capability, attitude of acceptance and collaboration, brief explanation,utilization of visual aids, adoption of objective evaluation, various acquisition of patients’ information, active listening, and sharing patients’ information were retrieved as subcategories. The highest level of attention to communication capability implies that community pharmacists certainly recognize their expected responsibility described in the government document titled “Vision for patient-centered pharmacies”. Conclusion: Community pharmacists face many challenges but have some practical strategies. Although part of such challenges is not for pharmacists themselves but for patients, other medical professionals, or entire health system, improving essential skills of pharmacists may havepositiveinfluenceto theother challenges.

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.

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.

  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.

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.

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.

BACKGROUND/AIMS: The relationship between the appearance of an ulcer and postoperative bleeding after gastric endoscopic submucosal dissection (ESD) is not well understood. To explore this potential relationship, we retrospectively analyzed the short-term healing process of ESD. METHODS: A total of 520 consecutive lesions in 434 patients seen between January 2004 and December 2009 were retrospectively investigated. At the second-look endoscopy, which occurred between 1 and 8 days after ESD, artificial ulcers were categorized into 6 patterns according to Forrest's classification: spurting bleeding, oozing bleeding, non-bleeding visible vessel, adherent clot, black base/spot, and clean base. From these data, a short-term healing model of the artificial ulcer was generated. RESULTS: Ulcer base changed gradually from a bloody to a clean one. The bleeding or non-bleeding visible vessel categories, which occurred in approximately one quarter of the ulcers within 3 days of ESD, were rarely observed 4 days after ESD. CONCLUSIONS: Ulcers that occur after gastric ESD heal in line with a specific time course, and it appears that most healing occurs without massive bleeding.
Endoscopy ; Glycosaminoglycans ; Hemorrhage ; Humans ; Retrospective Studies ; Stomach Neoplasms ; Ulcer