<p>With the revision of Japan's Long-Term Care Insurance Act in 2015, the government built community-based comprehensive care systems. It relies on reciprocity among local residents to provide some of the assistance the elderly need to avoid having to be moved into care facilities. Facilities providing support services have been required to arrange for places of social activities to be held and to create roles for elderly residents in the hope of increasing their participation in the community.</p><p>The person-to-person and person-to-community ties that created during these types of activities involving reciprocity among local residents can be understood as the concept of social capital (SC). SC is based on trust, shared norms, and networking. We have already shown in a study of the association between elderly people's mental health and SC that people with deep relationships of trust with others, many friends, and those who participate in community activities are psychologically healthier.</p><p>In this study, we use SC to discuss the effects of person-to-person and person-to-community ties on mental and physical health based on contrasts between the cases of A and B, whom we encountered while working at a community-based comprehensive support center. They lived in the same community, but case A had no contact with any local organizations and refusing public assistance, ended up isolated and dying alone. In contrast, case B lived independently, had ties to the community and to volunteers, participated in a variety of activities, had a role in the community, and something to live for. These two contrasting cases are used to illustrate topics related to social services for the elderly in Japan and what our future objectives should be. In addition, we use the example of "Daredemo Shokudou" ("Everyone's Diner" events held by local organizations that provide an inexpensive meal and activities for community members) to show the importance of providing independent living assistance for the elderly so that they may create ties with the community and build relationships of trust through community-based activities.</p>

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self-selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin-related, head-related, auditory and vestibular, musculoskeletal, allergy-related, sensory, and heart/chest-related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test-retest analysis, and high Cronbach's α coefficients (0.853-0.953) from each subscale. A comparison of scores of each subscale between self-selected EHS subjects and age- and sex-matched controls using bivariate logistic regression analysis, Mann-Whitney U- and χ(2) tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353-372, 2016. © 2016 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

Purpose：The purpose of this study was to clarify the practice of acupuncture and moxibustion in medical institutions with a palliative care unit. Methods：A selfadministered questionnaire was mailed to the physicians in charge of the ward or the chief nurses of 244 medical institutions with a palliative care unit. Results：Responses were obtained from 98 institutions. Among these, it was obvious that acupuncture and moxibustion therapy were performed in six institutions（6.1％）. The conditions of patients treated with acupuncture and moxibustion were pain, fatigue, constipation, and displeasure. Regarding acupuncturists being concerned with a palliative care field, it was described that acupuncturists could have one of the important role in clinical field in palliative care. On the other hand, it was indicated that there were difficulties associated with the practice of acupuncture and moxibustion therapy in a hospital. Conclusion：Although acupuncture and moxibustion therapy are considered to have usefulness as a variety of care, to practice acupuncture and moxibustion therapy in a medical institution, it is necessary to examine create the practice system.

Japan is facing an unprecedented aging society. In 2013, 25.1% of the total population in Japan was 65 years old and over. One third of the population in Japan will be at least 65 years old in 2035
healthy aging is crucial for public health and society in Japan. Under the budget limitations of social security, policies and frequent policy changes have created great uncertainty and concern for the elderly population. Given these circumstances, we conducted questionnaire surveys in 2010 to examine concerns in this age-group. In 2010, we sent questionnaires to university graduates 65 years old and older, randomly selected from a list of an alumni association of 11 universities. The questionnaires were open-ended and asked them to write any concerns that they had about health care, health policy, health systems, and their future. We received 344 responses. Among those who responded, 271 (78.8%) respondents said that they had concerns. We conducted a text analysis (Trend Search–Keyword Associator 2008) and extracted the keywords from their responses. The keywords that were extracted frequently included hospitals, doctors, health-care system, health care, Japanese government policies, government, medical insurance system for the elderly, support, increase, copayment, health (their own), scarcities, and burdens. In this study, many elderly people in Japan are concerned about health-care expenditures, health-care systems, and health policies. This may be caused by frequent health policy changes and uncertainty due to frequent administration changes such as the lack of clarity concerning raising the out of pocket payment rate from 10% to 20% for elderly people under budget constraints in Japan. Correct policy making and determination to eliminate the concerns from this vulnerable population in Japan are necessary for healthy aging.

Background : In Japan, over 30,000 people per year have commited suicide in the course of 14 years since 1998. It is clear that many workers suffer from workplace stress. Mental health wellness is addressed by the industrial world yet mental health insurance coverage for individual workers is extremely difficult. The purpose of this case study is to improve the conditions of, and make changes for, the workers of a small to mid-sized company (company XYZ) whose employee had committed suicide from a psychosomatic point of view. Methods : We investigated the mental state and the workplace relationships of the eleven coworkers who were left behind by the one who committed suicide. Through interviews and participant-observer approach, the coworkers' conversational data were collected, and then analyzed by the KJ method, to reveal their relationships to each other and their socio cultural background. Two years after measures to prevent the recurrence of suicide were implemented, the coworkers were interviewed again and pre- and post-preventative measure implementation differences were analyzed. Results : Immediately after the suicide, in a social context, interviewees expressed their suffering as physical, mental, social, and existential pain. In addition to being an employee, the one who committed suicide had social roles as a father and husband. After his death, his personal financial hardship and his lack of interpersonal relationships at the workplace were revealed. Many of his coworkers were dissatisfied with company xyz's feudal culture. Their suffering, which stemmed from the work environment and business procedures, was improved by the implementation of mental health education and measures to prevent the recurrence of suicide ; this resulted in vast improvements to employer-employee relationships and their understanding of each other. They have started to care for each other and their behaviors have started to change. Discussion : It is best when industrial medical professionals take care of workers from a psychosomatic perspective. If that cannot happen, outside resources like consultants and non medical professionals, as well as the employees themselves, have the potential to improve health by carrying out a medical anthropological approach to prevent the recurrence of suffering.

The term "metabolic syndrome" is one of the worldwide concepts in order to prevent various life-style related diseases, and it is utilized for national health programs in Japan. However, many problems and confusion are argued in clinical and health fields. This study aims to clarify social risks of the discourse of metabolic syndrome from the viewpoint of critical medical anthropology. Problems in the medical dimension are discussed in the 1st report, and problems in social dimension are in the 2nd report. In the process of making diagnostic criteria of metabolic syndrome in Japan, a committee was organized by eight Japanese societies of internal medicine such as Japan Atherosclerosis Society and Japan Society for the Study of Obesity. The committee held several meetings in 2005, but it continued only for one year and therefore it did not appear that enough discussions were conducted to make reasonable consensus. After these meetings, several issues that indicated problems of the Japanese criteria of metabolic syndrome were published by members of this committee. The summary of concerns regarding the metabolic syndrome is as follows. 1) It was not clarified that the diagnostic criteria of the metabolic syndrome is more valuable than that of the sum of its parts ; obesity, hyperlipidemia, hypertension, and hyperglycemia in order to prevent cardiovascular disease in clinical medicine. 2) There is no statistical evidence in the scale of waist measurement in Japanese diagnostic criteria. 3) When those criteria are used in national health services, economic benefit and loss must be evaluated precisely. Is it really possible to prevent cardiovascular disease and reduce the mortality from cardiovascular disease? Is it possible to reduce governmental medical expenditure? In this study, the medical dimension of social risks about the discourse of metabolic syndrome is discussed. There remain a lot of problems that must be resolved in order to achieve the well-being of Japanese citizens.

Many meditation exercises aim at increased awareness of ongoing experiences through sustained attention and at detachment, i.e., non-engaging observation of these ongoing experiences by the intent not to analyze, judge or expect anything. Long-term meditation practice is believed to generalize the ability of increased awareness and greater detachment into everyday life. We hypothesized that neuroplasticity effects of meditation (correlates of increased awareness and detachment) would be detectable in a no-task resting state. EEG recorded during resting was compared between Qigong meditators and controls. Using LORETA (low resolution electromagnetic tomography) to compute the intracerebral source locations, differences in brain activations between groups were found in the inhibitory delta EEG frequency band. In the meditators, appraisal systems were inhibited, while brain areas involved in the detection and integration of internal and external sensory information showed increased activation. This suggests that neuroplasticity effects of long-term meditation practice, subjectively described as increased awareness and greater detachment, are carried over into non-meditating states.

Many meditation exercises aim at increased awareness of ongoing experiences through sustained attention and at detachment, i.e., non-engaging observation of these ongoing experiences by the intent not to analyze, judge or expect anything. Long-term meditation practice is believed to generalize the ability of increased awareness and greater detachment into everyday life. We hypothesized that neuroplasticity effects of meditation (correlates of increased awareness and detachment) would be detectable in a no-task resting state. EEG recorded during resting was compared between Qigong meditators and controls. Using LORETA (low resolution electromagnetic tomography) to compute the intracerebral source locations, differences in brain activations between groups were found in the inhibitory delta EEG frequency band. In the meditators, appraisal systems were inhibited, while brain areas involved in the detection and integration of internal and external sensory information showed increased activation. This suggests that neuroplasticity effects of long-term meditation practice, subjectively described as increased awareness and greater detachment, are carried over into non-meditating states.

The functional somatic syndromes have acquired major socio-cultural and political dimensions. Socio-cultural factors clearly affect symptoms, suffering, and disability perception and reporting. And knowledge of explanatory models of bodily distress for patients from different cultural backgrounds is useful in the establishment of a stable doctor -patient relationship. FSS may be an operational category to bridge between medical explanatory model and patient's model. According to medical anthropology, sickness has two faces; illness and disease. "Disease" is the problem from the practitioner's perspective, and "illness" is the human experience of symptoms and suffering. In this paper, the anthropological research on chronic fatigue syndrome as "not real" illness experience was described.

Objectives: The purpose of this report is to show a key concept of Narrative-Based Medicine (NBM) through qualitative analysis of interactions between the patient, a doctor and a third person. We will now need to consider a plasticity of illness narratives more closely to understand this interactive relationship. Subjects and method: Illness narratives were collected from 20 outpatients at a clinic in Tokyo. From March 2000 to August 2000, we conducted non-structured interviews intensively to examine illness narratives. The subjects of this study were 5 patients who were placed in the 3rd stage of the Four-stage model (Table 1). This study adopted the qualitative research method from an anthropological point of view because it was necessary to mention the influence of researchers upon their subjects. Results: It has been recognized by our research that there is a process to refine illness narrative (Fig. 1). In the 3rd stage of the Four-stage model, patients become an expert of illness experience while medical doctors remain as a specialist of disease. Furthermore, we examined a key concept in NBM. We found that there are 3 aspects of witness in the 3rd stage (Fig. 2); (I) illness narratives of witness, (II) medical doctor as a witness person for their illness narratives, (III) researcher or family member as a second witness person for doctor-patient relationship. Conclusion: We found that each interaction among 3 aspects could be considered indispensable in order to conduct NBM effectively. It is sure that to witness a patient's daily life is one of the most important elements in NBM. Therefore, we named the interaction among 3 aspects Witness-Based Medicine.

Objectives : We argue for a key concept in "Narrative-Based Medicine" through detailed analysis of interactions in illness narratives. The purpose of this research is to illustrate that practical knowledge based on a patient's lived experience of illness has significant meanings and functions for medical treatments that advocate a holistic medical care. Subjects and method : Subjects of this research are 5 patients placed in the 3^<rd> stage of Four-stage model (1^<st> report). This research adopted the qualitative research method from an anthropological point of view, because it was necessary to mention the influence of a researcher upon subjects. An anthropological research for narrative analysis can deal with interactions among patients, a doctor and a researcher as academic agenda. Results : We examined illness narratives for clarification of a key concept in "Narrative-Based Medicine". It was clarified that illness narratives as "witness" were proving the truth of their illness experience. We found there are 3 aspects on dynamics of witness (Fig. 1); (1) illness narratives as witness of subjects in the 3^<rd> stage, (2) a medical doctor as a witness person for their illness narratives, (3) a researcher or a family member as a second witness person. We found that each interaction among these 3 aspects could be considered indispensable conditions in order to conduct medical treatments based on the dynamics of witness. Significance of illness narratives as witness lies in that subjects will be able to live together with chronic illness through interactions among these 3 aspects. Conclusion : In analysis of illness narratives in this research, it was clarified that the dynamics of witness in the above mentioned 3 aspects could generate medical phenomenon that encouraged patients to live together with chronic illness. We regarded the dynamics of witness as one of the key concepts of "Narrative-Based Medicine". Hence we named this medical phenomenon "Witness-Based Medicine".

Objectives:This research attempts to examine illness narrative as health resource in psychosomatic medical treatment. In clinical process, illness narratives in which explanatory models are implicated show considerable plasticity reflecting doctor-patient relationships. We argue for relevance of Narrative-Based Medicine, through detailed analysis of this plasticity in illness narratives. Subjects and Method:Illness narratives were collected from 20 outpatients at a clinic in Tokyo. From March 2000 to August 2000, we conducted non-structured interview in order to examine illness narratives qualitatively from an anthropological point of view. Results:We found that these illness narratives should be considered as health resources for every patient to cope with various stress-factors in their daily life. We hypothesized four-stage model of clinical process according to the observation on transition of doctor-patient relationship and changing contents of a patient's illness narratives. At the beginning of illness symptom, all patients suffer deeply from not being able to express their mind-body discrepancy verbally. At the first stage, they visit medical facility to seek an orthodox explanatory model of medical science. In the second stage, they begin to ask personal explanatory model of the doctor in charge. Finally, they become able to narrate their illness experience fluently, since they have developed a definition of their health conditions while maintaining mind-body discrepancy in certain degree. In the third stage, patients become an expert of "illness experience", while medical doctors remain as a specialist of "disease". Conclusion:It is clear that to continue narrating illness experience has important meaning and function for a patient's health care. In the third stage, some patients become enable to narrate their feelings and sensations particular to their bodily experience. At the same time, medical doctor respects their knowledge of bodily experience and shows proper attitude as audience in their illness narrative.

Medical anthropology is one of the branches of social and cultural anthropology, and it investigates the relationship between socio-cultural system and health and/or illness. The objective of this study is to clarify socio-cultural background of the clients in folk sector medicine in Japan, using qualitative research by medical anthropology method. Explanatory model which Kleinman A. defines as 'the notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process' was extracted and analyzed from each clients' illness story. The subjects are the clients of one folk sector healer who practice Oriental medicine, Buddhist medicine and Splritualism method. Semi-structured interview and free writing questionnaire were carried out. Characteristic state of diseases easy to use folk sector medicine was evaluated ; the mortal diseases such as cancer for which orthodox medicine has no effective treatments, and the chronic diseases that cannot be controlled completely by orthodox medicine, such as chronic pain and allergic diseases. Characteristic pattern of illness behavior to use folk sector mediclne was also evaluated. The first (75%) : those who use both folk and professional sector medicine. The second (25%) : those who use only folk sector medicine after finding professional sector medicine unsatisfactory. Diverse ideas that regarding life and death were identified by the clients who consult even the same healer. In the illness story, it was founded that each client subjectively selected suitable sector of medicine from the wide range of pluralistic health care systems based on their own sense of values and life stories. By this study, the importance of narrative based medicine (NBM) was indicated.

The multiple chemical sensitivities (MCS), a concept advocated by Cullen (1987), refers to a syndrome induced after low-dose but continuous exposure or high-dose and one-time exposure to various chemicals. The concept of MCS is not yet generally accepted and there is much debate even on the name of the syndrome. The objective of this study is to clarify the relationship between stress-related factors and MCS from psychosomatic perspectives. Subjects : We surveyed 18 patients with MCS (male; n=7,female; n=11,) and 35 controls (male;n=7,female; n=28) to investigate the effects of stress-related factors on MCS. The patients were diagnosed as having MCS in the Clinical Environmental Center of the Kitasato Institute Hospital. We recruited controls through an advertisement on a family magazine, who are healthy persons aged 20-70 without medication, and not diagnosed as having sick-building syndrome in spite of having moved to a new house or a reformed house during the past three years. Fulfilling these requirements, the controls were considered not suffering from MCS under continuous exposure to low-dose chemicals. Measurements : All subjects underwent the life health questionnaire (LHQ) which evaluates life events, daily hassles, social support, stress coping, smoking and drinking habit, physical, mental and behavioral stress responses. They were also examined for the following tests : The Cornell Medical Index-health questionnaire (CMI) for physical and psychiatric subjective symptoms, the Profile of Mood States (POMS), the Eysenck Personality Questionnaire-Revised (EPQ-R), the Twenty-Item Toronto Alexithymia Scale-Revised (TAS-20R), the Somatosensory Amplitude Scale (SSAS) and the Tri-Axial Coping Scale (TAC-24). They were also examined for the heart rate variability as the function of autonomic nervous system. In order to diagnose psychiatric comobidity, one psychosomatic doctor interviewed all of them by using the Mini-International Neuropsychiatric Interview and the items of somatoform disorders extracted from the Structured Clinical Interview for DSM-IV. Results : The scores of life events during the past one year and the present stress scores of patients were significantly higher than those of controls. However, there was no Significant difference recognized in specific personality trend or stress-coping style. A remarkable difference was noted in the volume of smoking and alcohol drinking in the past One month. No patients had smoked at all and few patients had drunk alcohol. After occurrence of MCS, the patients felt various physical and psychological symptoms. The rate of psychiatric comobidity of patients was 83%, while 11% of controls. The details of psychiatric diagnoses on the patients were Somatoform Disorders (67%), Mood Disorders (61%), Anxiety Disorders (50%) and so on. As for the heart rate variability as the function of autonomic nervous system, there was no difference between patients and controls. Conclusion : Psychological stress may promote the occurrence of MCS, but there was no distinctive psychological or behavioral profile of patients except that they smoked or dranked less. And MCS patients had many psychiatric comobidities.

The purpose of this study is to evaluate the effects of the Great Hanshin Earthquake in January 1995 on the onset of symptoms of the Posttraumatic Stress Disorder (PTSD) and psychological stress responses systematically. Three to four months after the quake, one hundred twenty eight earthquake victims (males : n-62,Age : Mean : =34.89±12.51,Min.=18,Max.=73; females : n=66,Age : Mean=29.56±11.42,Min.= 19,Max.= 62) were requested to complete a questionnaire, which consists of items from DSM-IV diagnostic criteria for PTSD and Psychological Stress Response Scale (PSRS-18). The rate of. prevalence of PTSD was 12.90% for males, 9.09% for females, and 10.94% for total subjects, suggesting that the prevalence rate of PTSD is almost same as one described in DSM-IV. Victims showed symptoms included DSM-IV criteria category B (persistent reexperience of traumatic events) most frequently (92.97%), followed by category D symptoms (persistent increased arousal : 54.69%), category F symptoms (distress or impairment of social and occupational functioning : 28-91%), and category C symptoms (persistent avoidance of trigger and numbing of responsiveness : 25.00%). Among category B symptoms, 82.03% of victims showed intense psychological distress at exposure to triggers, 69.53% of them showed recurrent and intrusive recollections of the traumatic event and acting or feeling as if the traumatic event were recurring, whereas only 15.63% of victims showed psychological reactivity on exposure to triggers. Among category C symptoms, efforts to avoid activities., places, or people that arouse recollections of the trauma was found in 69.53% of victims and sense of foreshortened future was found in 37.50% of victims. As there were no differences in the occurrence of category D symptoms, 35% to 50% of victims showed each symptom. Regarding to the results of PSRS-18,comparison of PSRS-18 scores between victims and the normative data revealed that victims showed significantly higher scores in all subscales : Depressive-anxious mood, Irritability and anger, and Helplessness. No significant gender difference was found. Further analysis of PSRS-18 scores revealed that victims with PTSD symptoms showed significantly more psychological stress responses than victims without PTSD symptoms in all subscales. These results were discussed with reference to past research data on PTSD caused by quake disaster. The importance of social support system to reduce psychological stress responses and some implications for the intervention of PTSD were discussed.

This study systematically evaluated the psychosomatic reactions, especially physical symptoms of the victims living in the temporary shelters after the Great Hanshin Earthquake in January 1995. There are not so many studies which describe the somatic symptoms of victims in detail and reveal the results of blood pressure measurement after a natural disaster. As there has been no research which excludes the confounding factors in order to evaluate the effects of damages, it is a distinctive feature of this study that the multiple logistic regression analysis was performed in it. Physical and mental conditions of eighty victims (mean age=47.2±19.3; males : n=27,females : n= 53) were examined one month after the quake. Subjects were also requested to administer a checklist of psychosomatic symptoms which consisted of DSM-IV diagnostic criteria for ASD and PTSD. Blood pressure of about two hundred victims was measured both two and five weeks after the quake. Subjects of two weeks after the quake were 191 victims (mean age=58.4±13.1; males : n=68,females : n=123), and five weeks after the quake were 217 victims (mean age=60.1±12.1; males : n=77,females : n=140). Victims showed significantly more physical symptoms of insomnia, easy fatigue, anorexia, headache, palpitation, chest pain than non-victims as a control group. It was also found that three factors of victims, i.e. morbidity of chronic disease, death of close relatives, and complete destruction of houses had influence upon prevalence of psychosomatic symptoms. More symptoms of common cold, anorexia, easy fatigue, depressive feeling were found in victims with chronic diseases. Victims whose close relatives were killed by the quake showed significantly more symptoms of easy fatigue and less symptoms of common cold and anorexia. Victims whose houses were completely destroyed showed more symptoms of insomnia and depressive feeling. Forty-one to forty-six percent of victims who had not suffered from hypertension before the quake showed hypertensive status. Therefore, neurological, cardiovascular, and general symptoms were the most common reactions after exposure to the stressors due to disaster. Furthermore, these symptoms were affected by the severity of the damages in the disaster. These results suggest that somatic symptoms are important components of the reaction after a natural disaster. They also suggest the importance of proper care from both physical and mental perspectives, i.e. psychosomatic or holistic perspective.