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.

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We usually evaluate effects of occupational therapy by observation of psychological stability or questionnaires. It is important to establish an evaluation method using biomarkers. Heart rate variability (HRV), employed as an index of cardiac autonomic function, has been used mainly in the field of anesthesia or internal medicine. In this case report we use spectral analysis of HRV to evaluate the effect of a psychiatric relaxation program. During the relaxation program average heart rate and ln LF/HF was smaller and ln HF was larger than at rest. These results suggest that parasympathetic nervous system activity was stimulated and sympathetic nervous system activity was suppressed during the relaxation program.

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The number of sudden deaths occurring during bathing in Japan has recently exceeded 10, 000 people and the 80% of these have occurred to the elderly. Although some guidelines for safe bathing are available, bathing-related accidents have still not declined. The purpose of this study is to use a questionnaire to survey the daily bathing habits of middle-aged and elderly people.
Method: For the subjects of this study, 77 middle-aged and elderly persons attending a healthful exercise class were given a questionnaire survey, and of these 10 persons were recruited at random and their daily bathing habits at home were studied. Results: The questionnaire survey revealed that almost all of the middle-aged and elderly people had unsafe bathing habits. In addition, a comparison of the questionnaire and the home habits study showed much discrepancy between the perceived and measured body and room temperatures before, during, and after bathing. Conclusion: Almost all middle-aged or elderly people had unsafe bathing habits.

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Infrared thermography was performed on 38 forestry workers. The thermograms were analyzed separately for the left and right hands of each subject. Of 75 hands evaluated, vibration-induced white finger was noted in 18 (VWF group), and no symptoms were noted in 57 (non-VWF group). In addition to the above two groups, 42 subjects (84 hands) who had no symptoms of vibration exposure were used as a control group. Based of the thermograms taken after a local warming of the hands for 5min, the temperature distributions of the dorsal aspect of subject's hands were evaluated, and the thermal images of the hand with VWF were categorized into three main patterns. To establish a quantitative evaluation index that incorporates the characteristic thermal image observed in the VWF group, we constructed the representative parameters for each of the three thermogram patterns, and a linear discriminant analysis was performed using the presence or absence of VWF symptoms as the dependent variable and the constructed parameters as the independent variables. A discriminant score derived from this model expression was used as the evaluation index. The accuracy of the index was estimated according to a receiver operating characteristic (ROC) curve, and the area under the curve of 0.942 was obtained (p<0.001). When the cutoff point was set at the maximum point in the Youden index, the sensitivity of the VWF group was 94.4%, and the specificity of the non-VWF group and control group was 84.2% and 89.3%, respectively. These findings suggest that this newly proposed quantitative analysis method, which uses the thermal distributions of the dorsal side of the hand as indicators, may be useful for evaluating peripheral circulatory impairment of HAVS.

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Renal plasma flow (RPF) and glomerular filtration rate (GFR) are decreased in patients with heat stroke. Heat stroke after prolonged exercise under high temperatures is usually associated with hypotension and dehydration, leading to decreased RPF. However, whether renal blood flow (RBF), RPF, and GFR are increased or decreased during immersion in mild warm water remains unknown.
Para-aminohippurate clearance (C_PAH), sodium thiosulfate clearance (C_thio), and creatinine clearance (C_cr) were determined in 14 healthy men aged 19 to 27 years old (mean±SD, 22±2), 161 to 181cm (171.5±6.3) tall, and weighing 52 to 78kg (64.2±7.4) without immersion at about 25°C (room temperature) and during immersion in water at 41±0.5°C.
C_PAH, C_thio, and RBF significantly increased during immersion compared with those without immersion (P<0.0001, P<0.03, P<0.0001, respectively). C_cr did not change (P=0.108). The filtration fraction (FF) was significantly decreased (P<0.001). Levels of plasma atrial natriuretic peptide, aldosterone, anti-diuretic hormone and renin did not significantly differ between these two conditions.
This investigation suggests that daily immersion at 41°C is beneficial for renal function.

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We performed a physio-psychological research on the mental, physical relaxation and health-keeping effect of Shinrin-yoku (forest walking) in Kawaba village. Eleven male and 8 female healthy elderly residents in Kawaba village, whose average age was 74.0±3.5 years old for male and 74.9±2.9 years old for females volunteered for this experiment. All members walked for one hour in the Kawaba Forest on August 17 under cloudy skies, 30-32°C temperature, 58-60% humidity, and, 0-2m/sec wind condition and walked again for another one hour in a non-forest rural agricultural area on August 21 under almost the same weather conditions. Phytoncides in the air, Profile of Mood State (POMS) test, blood pressure (BP), heart rate (HR), fasting levels of serum natural killer cell activity (NK), plasma catecholamine (adrenaline, noradrenalin and dopamine), plasma cortisol, and serum adiponectin were measured before and after walking. Phytoncides were detected in the forest and non-forest, all members showed a decrease of POMS total scale, BP, adrenalin and serum cortisol. Six (3 male and 3 female subjects) of them expressed an increase of serum NK cell activity after the forest-walking. One female showed a high serum NK cell activity after both forest and non-forest rural walking.
Our experiment on the forest-walking in Kawaba village indicated that its relaxation and health-keeping effects, probably due to walking in the fresh forest air.

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