[Purpose] Acral coldness is a condition in which the fingers and/or toes are cold despite normal central body temperature. Regardless of the presence or absence of disease, many people suffer from acral coldness, especially elderly people. One method of relieving acral coldness is to heat the hands with a disposable warmer called “Kairo,” but this method interferes with daily work. We investigated whether or not heating other upper-limb parts with a pair of warmers can relieve acral coldness.

  [Methods] After obtaining informed consent, 30 people who usually had acral coldness without other diseases received the Kairo holders for their necks, elbows, and wrists. Eighteen participants used a pair of Kairo warmers for each area for one week, respectively. The remaining participants wore only the holder to know the heat retention effect of the holders. All participants separately evaluated their acral coldness of the upper limbs and the cumbersomeness of holders and/or Kairo by using a 10cm visual analog scale (VAS). To measure the therapeutic effect of the Kairo, the temperature and blood flow of the surface of both hands were examined by thermography and laser speckle contrast analysis (LASCA) at the day after finishing each warming period. These evaluations were conducted after a 20-minute adaptation at 24°C.

  [Result] The VAS of acral coldness of upper limbs decreased during the periods of warming on the neck and elbows with Kairo compared to the period without Kairo. There was no difference in the VAS value of the cumbersomeness among the neck, elbows, and wrists areas. The hand temperature on the day after the end of warming decreased slightly after elbow warming.

  [Conclusion] We found that the coldness of the hand was improved by warming other parts, even if the hand was not warmed, but the effect varied depending on the warming area. No therapeutic effect was detected, but this was considered to be a problem in setting the measurement conditions. We believe these results will lead to new ways to improve acral coldness.

  [Purpose] It has been reported that foot warming can improve flexibility and standing balance. The purpose of this study was to examine the effects of plantar warming, skin temperatures, feet sensations, and plantar flexibility on balance ability.

  [Methods] Study participants included 30 healthy young adults for both the warmed and non-warmed conditions. Plantar warming was carried out for 15 minutes using a foot heater. Deep temperatures (1-2 and 4-5 metatarsal bones on the dorsal-side of the foot) and surface skin temperatures of the dorsal-side (lateral 5th metatarsal head on the right and left feet), Y Balance Test (YBT), and area of one leg stance (OLS) postural sway were measured before and after warmed/non-warmed conditions, and also after 10 minutes (after10) warmed/non-warmed conditions. Semmes Weinstein monofilament (tactile sense), vibration sense, contact area of the plantar on OLS tests and toe extension angle value were measured before and after warmed/non-warmed conditions. Change ratios were calculated for non-temperature items and compared using repeated measures analysis of variance and Wilcoxon’s signed rank test.

  [Results] Deep temperature, surface skin temperature of dorsal, and surface skin temperature of the plantar were significantly increased by warmed condition. After- and after10-warmed YBT reaching distances increased significantly compared with before-warmed distances for both the warmed and non-warmed conditions. No significant differences were found between before- and after-warming OLS postural sway area, Semmes Weinstein monofilament, vibration sense, and OLS plantar contact area results. Change ratios of YBT and toe extension angles were significantly increased in the warmed condition compared with the non-warmed condition.

  [Discussion and Conclusions] YBT, an index of dynamic balance ability, was significantly increased after the plantar of the foot was warmed, confirming that foot warming does indeed improve balance. We also be observed significant increases in skin temperature and toe extension angles, but no significant changes in OLS postural sway area, Semmes Weinstein monofilament, vibration sense, and OLS plantar contact area. Increased YBT and expansion of toe extension angles suggest that plantar flexibility can be improved by applying a dynamic stretching stimulus after warming of the plantar, which will also enhance balance abilities.

  Objective: Various psychosocial factors were exploratively investigated in order to specify items that influence on immediate effect of acupuncture among patients with chronic low back pain.

  Method: Fifty-six outpatients with initial diagnosis of chronic low back pain, visiting the Acupuncture Department of Center for Integrative Medicine, Tsukuba University of Technology between August to December 2019 were included in the study. The baseline lumbar pain intensity of the patients evaluated using the Visual Analogue Scale (VAS) was >30 mm. Psychological scales viz., Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), social factors (cohabitation family situation, final education, social participation status), lumbar dysfunction, and impression on acupuncture were recorded using a self-administered questionnaire during the first visit. Patients showing decreased VAS scale (≦30 mm) after the first acupuncture treatment as well as self-recognition of improvement in pain were classified as “high responders” while the others were treated as “low responders”. Physical and psychosocial factors were exploratively compared between high and low responders and logistic regression analysis of the two groups was performed using a dichotomous dependent variable.

  Results and Discussion: The number of high and low responders were 22 and 34, respectively. On comparing these groups exploratively, positive (P＝0.001) and negative (P＝0.004) impression on acupuncture were the only items that showed statistical significance. Among items used as covariates in the logistic regression analysis, the PCS (OR: 0.886 (95% CI: 0.808 to 0.971); P＝0.010), positive impression on acupuncture (OR: 5.085 (95% CI: 1.724 to 15.002); P＝0.003), and number of people living together (OR: 0.355 (95% CI: 0.149 to 0.844); P＝0.019) showed statistical significance. Hence, it may be suggested that psychosocial factors influence the immediate effect of acupuncture among patients with chronic low back pain.

  Introduction: We examined the thermophysiological effects of ultrafine bubble (UB) bathing in comparison with microbubble (MB) and freshwater (FW) bathing.

  Subjects and Methods: Seven healthy women aged 35.6±2.9 years provided informed consent to participate in the study. After a 10-min rest, each subject engaged in UB, MB, and FW bathing (on separate days) at 40°C for 10 min. During the experiment, tympanic temperature, local sweat rate, local skin temperature, heat flow, and heart rate variability were continuously recorded. Subjective assessments of thermal sensation and comfort were rated on a visual analog scale between 0 to 100.

  Results: Increases in tympanic temperature and mean body temperature were highest during MB bathing, and similar increases were observed during UB and FW bathing. Local sweating was highest during MB bathing and lowest during UB bathing. A significant interaction was observed between local sweating during bathing and bathing style (P<0.001). The increase in local sweat rate relative to body temperature was lowest during UB bathing and highest during MB bathing.

  Discussion: During UB bathing, UBs and MBs that were generated in high concentrations in the bathtub decreased the flow of heat to the body, thereby suppressing an increase in tympanic temperature and yielding the lowest local sweat late. However, during MB bathing, in which a moderate concentration of UBs and MBs were generated, the increase in heat flow due to the convection of hot water exceeded the decrease in heat flow due to the bubbles.

  Conclusions: The results suggest that bubble properties and convection characteristics altered the balance of heat flow, leading to differences in the thermoregulatory response during and after bathing.

  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.

  In the health resorts of Germany, the empirical effects of the unique natural capital and environment on humans are verified by scientific methods such as medicine, meteorology, and chemistry, and then approved as therapeutic drugs. Natural capital is provided in various forms for the maintenance of health, treatment of diseases, and recovery from fatigue and stress. Natural capital include hot springs, natural gases, and peloid (from the soil), as well as climate and oceans. The categorization of health resorts is defined by the type and quality of natural capital available. Due to their unique characteristics, a system that allows users to select the health resorts that suit their specific needs has been established, enabling them to utilize natural capital effectively for health promotion.

  Considering the current state of Japan, country with an abundance of natural capital that is considered underutilized, we visited Bad Homburg and six health resorts located in Germany’s Black Forest located in the southwestern part of the country to learn about the current state of their health resorts.

  All the health resorts we visited were excellent centers certified by the German Spas Association and German Tourism Association. Bad Wildbad and Keidel Mineral-Thermalbad, both thermal health resorts, maintain the provision structure for medical treatment and tourism. Against a background of growing interest in the environment, they utilize the land and natural capital to their advantage by incorporating the elements of trendiness, fun, and excitement to revitalize the local and the health resorts’ communities.

  Due to the differences in the structure, environment, and systems between the hot springs in Japan and those in Germany, it would not be easy to apply the current state of the German health resorts to similar resorts in Japan. However, Japan is rich in natural environments such as forests and hot springs and is blessed with a quantity and diversity comparable to that of Germany’s Black Forest. Therefore, we believe that there is potential for further utilization of Japan’s natural capital for health promotion. The efforts of the German health resorts could direct and inspire us.