Mothers and daughters-in-law: a prospective study of informal care-giving arrangements and survival in Japan

<p>Abstract</p> <p>Background</p> <p>Daughters-in-law have played an important role in informal care-giving arrangements within East Asian traditional norms. The aim of this study was to measure the impact of daughter-in-law care-giving on the survival of care recipients. We prospectively examined the associations between different types of kinship relationship between the main family caregiver and the care recipient in relation to survival among care recipients.</p> <p>Methods</p> <p>A questionnaire was administered to Japanese community-dwelling seniors who were eligible to receive national long-term care insurance (LTCI) community-based services. Among 191 individuals whose informal care-giving arrangement was definitively determined, we observed 58 care recipients receiving care from spouses, 58 from daughters-in-law, 27 from biological daughters, 25 from other relatives, and 23 care recipients living alone.</p> <p>Results</p> <p>During 51 months of follow-up from December 2001, 68 care recipients died, 117 survived, and 6 moved. Hazard ratios of each care-giving arrangement were estimated by Cox proportional hazard models adjusted for care recipients' demographic factors, their care needs level based on their physical and cognitive functioning and their service use, caregivers' demographic factors, and household size. The highest risk of mortality was found for female elders receiving care from daughters-in-law (HR 4.15, 95% CI 1.02-16.90) followed by those receiving care from biological daughters (HR 1.64, 95% CI 0.37-7.21), compared to women receiving spousal care. By contrast, male elders receiving care from daughters-in-law tended to live longer than those receiving care from their spouses.</p> <p>Conclusions</p> <p>Our finding suggests that there may be a survival "penalty" for older Japanese women who are cared for by their daughters-in-law.</p

Crisis and change in the system of innovation: The Japanese pharmaceutical industry during the Lost Decades, 1990–2010

This article uses the experience of the Japanese pharmaceutical industry to show how Japan's national system of innovation evolved from a closed, firm-based domestic system toward a more open, networked, global system. This occurred in the face of a crisis of economic and technological dimensions. During the Lost Decades, the nature of innovation in this industry shifted from incremental toward more radical innovation, as the system internationalised and as firms leveraged different environments around the world. This article highlights the varying roles that the components of the system of innovation play in shaping innovative industries. It also shows how institutions can be remarkably malleable in times of crisis