Rural Japan Research Articles

“Place making” in Kawakami: aspirations and migrant realities of Chinese “technical interns”

In this paper, I examine Chinese agricultural labor migrants’ experiences in rural Japan. The research is based on multi-sited ethnography, mainly in Kawakami, a village located in central Japan, from July to November 2012. I go beyond the labeling of Chinese migrants as passive victims of difficult work conditions and exploitation, which pervades much of the literature on international migration, and argue that Chinese peasant workers possess an agency to negotiate, navigate, and survive in the village. The strategy they take is to contest over local institutions to build up their own “places,” where they can find provisional security, a sense of relief, and mutual support. These “places” further facilitate the formation of the social networks among the workers, although this is officially repressed by the dominant society. A functioning social network plays a significant role to help workers adapt, overcome difficulties, and exercise their agency in a more effective way.

The first nurse practitioner graduate programme in Japan.

AimThis paper describes the establishment of the first Japanese nurse practitioner graduate programme and legislative activities to institutionalize nurse practitioners in Japan.BackgroundTo address the super-ageing population, Oita University of Nursing and Health Sciences initiated the first academic graduate level nurse practitioner programme in Japan, based upon the global standard defined by the International Council of Nurses.ConclusionIn 2010, Oita University of Nursing and Health Sciences graduated the first nurse practitioner. We believe that nurse practitioners will be highly valued in Japan for thoughtful nursing care to the fragile elders living in rural and urban Japan.

Belief in life after death, salivary 3-methoxy-4-hydroxyphenylglycol, and well-being among older people without cognitive impairment dwelling in rural Japan.

Research has found that spirituality/religiosity has a salutary association with mental/physical health. However, the association of belief in life after death with well-being has rarely been studied, and the same is true of its association with biological indices, such as monoamine transmitters. Therefore, we examined the associations between well-being and religiosity, salivary 3-methoxy-4-hydroxyphenylglycol (sMHPG), and demographic characteristics. The participants were 346 community-dwelling people, aged 65 years or older, without cognitive or mental deficits, in rural Japan. Measures of religiosity consisted of belief in life after death, attachment to life, and experiences related to death and religion. The measures were assessed by scales specifically suited for Japanese religious orientations. Participants' well-being was assessed by a life satisfaction scale containing two subscales. We also measured sMHPG, a major metabolite of noradrenaline that is thought to reflect certain psychological states, such as psychomotor retardation and effortful attention. One subscale of life satisfaction was positively associated with belief in life after death and sMHPG, and the other life satisfaction subscale was positively associated with education and death/religion-related experiences (e.g., visiting family graves or loss of a friend). Gender differences were found in afterlife beliefs and each life satisfaction subscale. These results suggest that religiosity, including belief in life after death and death/religion-related experiences, is salubriously associated with mental health among older people, especially women, living in rural Japan. The basal level of sMHPG was positively associated with life satisfaction, but not with belief in life after death.

Serious adverse events and compensation in registration trials: a review of data from a Japanese university hospital.

BackgroundClinical trials leading to regulatory approval, or registration trials, play a central role in the development of drugs and medical devices. The contribution of support staff, such as the clinical research coordinator (CRC) and administrative officers, in registration trials is now widely recognized. Attending to serious adverse events is an important duty of the CRC and investigators alike, and managing these complications and compensation constitutes a key responsibility. We retrospectively examined the frequency of serious adverse events and compensation events reported from 2007 through 2011 at Tokushima University Hospital, an academic hospital in rural Japan. We present herein the results of our analysis.ResultsOver the five-year period, 284 subjects participating in 106 registration trials experienced a total of 43 serious adverse events, and eight compensation events were documented. Among the serious adverse events, 35 (81.4%) were considered not related to the investigational drug, and 17 (39.5%) resulted in withdrawal of the study drug. Patients with malignant diseases experienced serious adverse events significantly more frequently compared to those with non-malignant diseases (28.3% versus 8.2%, respectively; P < 0.01).ConclusionsThe CRC should be vigilant for serious adverse events in oncology clinical trials due to the generally higher frequency of these complications in subjects with malignancy. However, on an individual basis, the CRC may be seldom involved in the process for compensating serious adverse events. Therefore, the CRC’s ability to share such experiences may serve as an opportunity for educating clinical trial support staff at the study site as well as those at other sites. However, further study is warranted to determine the role of the clinical trial support staff in optimizing methods for managing adverse events requiring compensation in registration trials.

Cultural capital associated with children’s food consumption and physical activity among parents of first and second grade children in urban, suburban, and rural Japan (1014.1)

This study examined children’s food consumption and physical activity and their parents’ cultural capital levels in three Japanese communities. A total of 729 parents of first and second grade children enrolled in nine elementary schools in Chiba (urban), Niigata (suburban), and Miyazaki (rural) participated in a survey. Factor analysis resulted in three cultural capital variables: preservation of traditional Japanese food culture, parents’ aversion to Western foods, and parents’ openness to foods from other cultural groups. Correlations and ANOVA were used for statistical analysis. Children in Chiba consumed significantly higher amounts of store bought vegetables, fruits, and Western franchise fast foods compared to children in Miyazaki. Consumption of local vegetables was the highest in Miyazaki. Preservation of traditional Japanese food culture was associated with a higher level of physical activity among children. Western food aversion was associated with consumption of fresh vegetables and local/seasonal foods. Openness to trying foods from other cultures was associated with consumption of sweetened beverages. Our findings underline the significance of identifying cultural capitals for child health. These may ultimately contribute to developing policies and programs for healthier feeding practices in countries that are undergoing nutrition transition.Grant Funding Source: CSU Research grant

Tradition in transition: Historical, contemporary and future wasp husbandry in central rural Japan

Tradition in transition: Historical, contemporary and future wasp husbandry in central rural Japan

Community-Based Care of the Elderly in Rural Japan: A Review of Nurse-Led Interventions and Experiences

Nurses play a critical role in delivering care to elderly people at primary health care level but there is no synthesis of research knowledge to guide community nursing practice in Japan. This review aims to identify nurse-led interventions that have been found to improve elder health at village level; the barriers and constraints that service providers face when delivering care to the elderly; and the experiences of elderly people and their caregivers. The electronic databases such as MEDLINE, CINAHL and Google Scholar were searched to retrieve peer-reviewed primary research literature. A narrative synthesis of the findings sections of the papers was applied to identify key themes. These themes are: socioculturally appropriate care; health improvements; barriers and constraints to care delivery and; experience of the elderly and families. Seven papers were included in the review. The synthesis identified that nurse-led health care for the elderly in rural Japan can be effective when it is targeted and culturally sensitive. The studies highlight a number of barriers to the provision of care. There is a need for further research to examine the issues affecting access to rural nursing care including health system factors, as well as the needs of the elderly and families themselves. Such studies will better inform the delivery of programs, reduce inequity and provide socio-culturally appropriate care to improve the well-being of the elderly.

Association of salivary cortisol levels and later depressive state in elderly people living in a rural community: A 3-year follow-up study

BackgroundLate-life depressive disorder is becoming an important issue in health economics in the world, as it has been reported to be one of major risk factors for incidence of dementia. Identification of predictive markers associated with depression in later life is therefore of high priority in public health. The aim of the study was to examine the association of salivary cortisol levels with a later depressive state in elderly healthy people living in a rural Japan community. MethodsSalivary cortisol levels were measured in 68 elderly healthy people (24 men; 44 women) followed by completion of the BDI, MMSE, and FAB from 2004 to 2006. The same cohort underwent BDI again from 2007 to 2009. ResultsIn healthy elderly women subject, a significant positive correlation was found between salivary cortisol levels at baseline and BDI scores at follow-up, but not at baseline. Salivary cortisol levels at baseline were not correlated with the score of either MMSE or FAB. When the cut-off point of BDI scores were set at 20/21, logistic regression analyses revealed that salivary cortisol levels at baseline had a significant positive relationship with a later depressive state. Age and gender were also significantly related with a later depressive state. LimitationsThe present study involves small number of participants. ConclusionsHigher salivary cortisol levels were associated with a later depressive state in elderly healthy women living in rural community. Salivary cortisol might be a predictive marker for a later depressive state in elderly women.

Globalization, localization and food culture: perceived roles of social and cultural capitals in healthy child feeding practices in Japan

The current study examined parental perceptions of sociocultural factors associated with healthy child feeding practices among parents of preschool-age children in rural Japan. Fifteen Japanese mothers of preschool-age children participated in this qualitative study. These participants were aged 22-39 years and resided in a rural town in western Japan. We conducted semi-structured qualitative interviews to assess parental perceptions of healthy child feeding practices and their relationships with globalization and localization. These interviews were transcribed, translated into English and coded, based on the principles of grounded theory. A codebook was developed and pre-identified, and the newly-identified themes from this codebook were examined and compared. Overall, local and seasonal foods, along with traditional Japanese foods and simple foods (soshoku), were considered to be beneficial for children. Participants also noted that children were expected to be mindful and exhibit good table manners that reflect cultural values related to meal-time socializing or family bonding, and food appreciation. On the other hand, the majority of the participants stated that foods containing food additives and imported foods were unsuitable for children. Participants noted that strong social capital, especially social support from their mothers or mothers-in-law, as well as social networks for obtaining fresh local foods, contributed to healthy child feeding practices. Cultural capital (including the preservation of traditional Japanese dietary habits, eating rules and inter-generational commensality), was also identified as being key to healthy feeding practices. Identifying and promoting the social and cultural capital that positively support healthy child feeding practices may be an important component of nutrition education programs.

Determinants of changes in physical fitness after a square-stepping exercise program in community-dwelling older Japanese females

The purpose of this study was to investigate determinants of changes in physical fitness after a fall-prevention exercise program in older females. The study subjects included 83 community-dwelling females 65 years of age or older (mean age: 70.4±4.0 years) living in Kasama City, rural Japan. All subjects participated in a fall-prevention exercise program called square-stepping exercise (SSE) conducted once a week for 11 weeks. In order to assess the physical fitness benefits of by the exercise program, we measured the results of five physical performance tests: grip strength, one leg stand, sit and reach, timed up and go and the choice-stepping reaction time. In addition, we evaluated comprehensive physical fitness scores based on the standardized total score of the five physical performance tests. The changes in the comprehensive physical fitness score between baseline and after the program was used as the dependent variable, while the baseline values of age, education, clinical history, physical activity, Lubben social network scale, geriatric depression scale, five cognitive function test result, comprehensive physical fitness score and percentage of attendance were treated as independent variables. A stepwise multiple regression analysis revealed that the change in comprehensive physical fitness score correlated significantly with the baseline values of age (β=-0.273), the five cognitive function test result (β=0.293) and comprehensive physical fitness score (β=-0.607). These results suggest that older females with a low level of physical fitness at baseline are more likely to improve their physical fitness with a period of exercise training. However, the improvements in physical fitness are lower in older females with a low level of cognitive function than in those with a high level of cognitive function.

A Landscape of "Undesigned Design" in Rural Japan

Rural landscapes have long stimulated nostalgia for a simpler time and place. In contemporary Japan, real economic and social problems in the countryside have brought new attention to the role of rural communities in the formation of Japanese identity. In this paper I introduce Kurokawa, a hot springs resort that has spent the past three decades emulating the rural idyll through what it calls f ūkeizukuri , or “landscape design,” en route to becoming one of Japan’s best known rural tourist destinations. I contextualize Kurokawa’s adoption of a themed landscape in the mid-1980s, and explain the design choices that have gained Kurokawa so much attention, including those found in the built and natural environment. Here, I emphasize the role local actors have played in creating and enacting the landscape. I conclude by showing how the village’s adoption of a nostalgic rural theme has strengthened its status as not only an exemplar of the idealized aesthetics and social relations of the past, but also a rare rural community successfully adapting to the present.

Screening for depression: a systematic review and meta-analysis.

The Canadian Task Force on Preventive Health Care has a guideline on screening for depression among adults 18 years of age or older at average or high risk for depression. To provide evidence for an update of this guideline, we evaluated the literature on the effectiveness of screening for depression in adults. For the period 1994 to May 23, 2012, we searched the following electronic databases: MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Randomized controlled trials, observational studies and systematic reviews with evidence for the benefits or harms of screening for depression were eligible for inclusion. We performed screening for relevance, extraction of data, analysis of risk of bias and quality assessments in duplicate. We used the generic inverse variance method to conduct a meta-analysis. To determine confidence in the effect, we analyzed the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Five quasi-experimental studies (before-after design with a nonrandomized control group) met the inclusion criteria for this review. These studies reported on the effect of community-based screening for depression, with follow-up on the risk of suicide completion, for older residents in regions of rural Japan with high suicide rates. Meta-analysis showed that the screening program had a protective effect on the overall incidence of suicide completion (ratio of rate ratios [RRR] 0.50, 95% confidence interval [CI], 0.32-0.78). When sex was considered, the RRR indicated a significantly lower rate of suicide among women (RRR 0.37, 95% CI 0.21-0.66) but not among men (RRR 0.67, 95% CI 0.35-1.27). The overall GRADE rating applied to this evidence indicated very low quality. No studies addressing the harms of screening for depression met the inclusion criteria for the review. There is very limited research evidence allowing conclusions about the effectiveness of screening for depression in either average-risk or high-risk populations.

Mini Nutritional Assessment as a Useful Method of Predicting the Development of Pressure Ulcers in Elderly Inpatients

To determine the usefulness of the Mini Nutritional Assessment (MNA) and plasma amino acid analysis in predicting the formation of pressure ulcers (PUs) in inpatients. Prospective, observational cohort study with a mean observation period of 62.2 ± 86.4 days. Intermediate and acute care wards of a hospital in rural Japan. Inpatients with an average age of 85.0 ± 7.6 (N = 422). Mini Nutritional Assessment, Subjective Global Assessment (SGA), Braden Scale (PU prognostic score), PU formation, and biochemical analysis including plasma amino acid concentrations. PUs developed in 7.1% of participants. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of less than 15 in predicting future PUs. The area under the receiver operating characteristic curve (AUC) of the MNA was superior to that of the Braden Scale. The Braden Scale nutrition subscore had the lowest AUC of the six Braden Scale subscores. Individuals who developed PUs had significantly lower plasma arginine concentrations than those who did not. Mini Nutritional Assessment was able to predict the development of PUs. A MNA score of less than 8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the AUC for arginine was not significantly different from 0.50. The findings from this prospective study support the use of nutritional assessment in inpatients to predict PU risk and target appropriate interventions.

Tourism and the Revival of Rural Japan: The Case of &lt;I&gt;Satoyama&lt;/I&gt; Development in Ishikawa Prefecture, Japan

Tourism and the Revival of Rural Japan: The Case of &lt;I&gt;Satoyama&lt;/I&gt; Development in Ishikawa Prefecture, Japan

Everyday articulations of prostitution: how some Filipina migrants in rural Japan describe sexual–economic relationships

This article draws attention to ‘everyday articulations of prostitution’: the diverse, performative ways that people reproduce and rework meanings of ‘prostitution’ as they mobilize the term in their day-to-day lives. The article offers an ethnographic illustration of this process by exploring why and to what ends a group of Filipina wives of rural Japanese men referred to the behavior of another Filipina woman in their community as ‘prostitution.’ It demonstrates that when mobilizing this term, these Filipina women were not categorizing sexual–economic relationships (like ‘prostitution’) in terms of payment systems, as other scholars have assumed. Rather, geographical and cultural factors, such as the stigma associated with these women's migration histories and their long-term residence as wives and mothers in the small rural communities where they had worked in bars, led Filipina women in Central Kiso to describe such relationships according to the sentiments motivating them, the ways one utilized gifts or money from a sexual partner, and whether or not one demonstrated appreciation of this financial support. The article maintains that attention to everyday articulations of prostitution such as these expands our understandings of the situated meanings people can invest in this term. It illustrates how culture and geography shape the ways discourses of prostitution are mobilized to stigmatize some intimate-economic behaviors and, thereby, legitimize others.

Bullfighting, Self-Enhancement, and Well-Being in Rural Japan

Abstract This ethnographic study explores bullfighting in Oki and its many functions in contemporary life. It examines how mostly elderly bullfighters differ from other Japanese of their age and how they manage to lead their lives to the fullest, maintaining a high level of physical and mental health. With depictions of both the daily routine and bullfighting events, the paper enquires into the meaning of bullfighting and its related activities for actors involved in it, how bullfighters learn social skills in the stables and the arena, and how bullfighting creates well-being both on an individual and collective level. The hypothesis is that the sense of satisfaction of bullfighters accrues from a balance of activities as discrete individual and social interaction, communication, and intergenerational exchange.

Age and gender differences in correlations of leisure‐time, household, and work‐related physical activity with physical performance in older Japanese adults

This study aimed to compare relationships of leisure-time, household, and work-related physical activity (PA) with physical performance by age and gender in older Japanese adults. This cross-sectional study included 525 community-dwelling older adults (73.3 ± 5.2 years) recruited in 2009-2011 in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess PA variables. Physical performance was evaluated by 11 performance tests: grip strength, single-leg balance, functional reach, sit-and-reach, standing time from long sitting position, sit-to-stand, timed up and go, habitual walk, hand working, and simple and choice reaction times. After adjusting for potential confounders, leisure-time PA in young-old (≤ 74 years) men correlated significantly with eight performance tests (absolute value of Spearman's partial rank correlation coefficient: r = 0.18-0.39), whereas in old-old (≥ 75 years) men it correlated with three performance tests (r = 0.20-0.23). Although leisure-time PA correlated with six performance tests (r = 0.19-0.22) in young-old women, there were no significant correlations between leisure-time PA and performance tests in old-old women. Household PA of young-old men (r = 0.20-0.23) and old-old women (r = 0.26-0.34) correlated with four performance tests. In old-old men and young-old women, no significant correlation was found between household PA and performance tests. Work-related PA did not relate significantly to any performance tests in any groups. This study showed that leisure-time PA is related to physical performance, especially in young-old men and women, and household PA is especially related in young-old men and old-old women. Our findings suggest that supporting strategies for maintaining physical functions would differ by gender and age.

Treasure Hunts in Rural Japan: Place Making at the Limits of Sustainability

ABSTRACT Locality studies, a form of community mapping, emerged as a popular technique of sustainable development in early‐21st‐century Japan. Its proponents contend that by cataloging the features of their surroundings rural residents can “rediscover” dormant resources and mobilize civic energies to sustain homes hollowed by decades of persistent socioeconomic decline. Despite its empowering potential, the practice of locality studies also reflects a political climate of devolving responsibility epitomized by decentralization reforms that demand greater autonomy and self‐reliance of Japan's regions. Through an ethnographic examination of locality studies and debates surrounding its practice in Japan's northeastern Tōhoku region, I argue that it embodies a politics of recognition suited to an era of state streamlining. Its diverse proponents encourage residents of Tōhoku's mountainous peripheries to convert legacies of marginalization into celebrations of cultural diversity as a way of shifting responsibility for the future of the depleted countryside onto its inhabitants.

Concrete Results?: The TVA and the Appeal of Large Dams in Occupation-Era Japan

Progressive Japanese economic thinkers and U.S. policymakers promoted the Tennessee Valley Authority (TVA) as a model for post–World War II water use. In the late 1940s, when the escalating cold war called the future of international trade into question, these thinkers embraced the TVA model as a way to rebuild the country by converting Japan’s hydrosphere into a reliable domestic source of energy. They steadfastly endorsed state-guided hydrologic projects as a means of fostering social democratization, raising living standards, providing employment opportunities, and instilling a “rational” way of daily life in rural Japan.

Prevalence of depression among outpatients visiting a general internal medicine polyclinic in rural Japan

ObjectiveIn Europe and the US, primary care has been anticipated in identifying untreated depression. Findings show a high prevalence of depression in such settings. However, the prevalence of depression in an internal medicine clinic in a rural area of Japan, which has a role in primary care, is unclear. MethodThe prevalence of depression and comorbid psychiatric disorders among outpatients of an internal medicine clinic in a rural general hospital was measured by a structured interview using the Mini International Neuropsychiatric Interview. Outpatients were recruited consecutively and stratified by Patient Health Questionnaire-9 (PHQ-9) scores. Among 598 outpatients, we interviewed 75 randomly selected patients and 29 whose results of the PHQ-9 were positive. We estimated prevalence of depressive episode using age, sex, physical findings by internal medical doctors and PHQ-9 scores as covariates. ResultsThe estimated prevalence of major and minor depressive episodes were 7.4% [95% confidence interval (CI): 3.4%–11.4%] and 6.8% (95% CI: 2.6%–10.9%), respectively. Among major depressed patients, 71.4% had current suicidal ideation. ConclusionGiven the high rate of depression and suicidality, identification of depression and collaboration between internal medical doctors in a rural area of Japan and mental health professionals are needed.