Since the mid-1990s Japanese society has entered a period of major change. The previous patterns of social order and social integration have collapsed, and it has become increasingly difficult to envision a stable life course for oneself. The 'secure' foundation has been weakening and anxiety has spread at an accelerated pace. Japan could enter the age of second modernity, or reflexive modernization. In Japan's first modernity, the mechanism responsible for risk management, an integrated society, and stabilized social order, was, first, private corporations that guaranteed long-term stability for employees and their families (company-centrism) and, second, land development rapidly implemented under the guidance of bureaucrats (developmentalism). From the 1990s, these systems were fundamentally destroyed by globalization and neoliberal policies. Private corporations limited the groups that could benefit from the seniority wage system, undermining in-house welfare benefits. The government abandoned its role of improving the industrial and economic conditions of surrounding areas through offering public works projects. After these risk-stabilizing mechanisms were gone, two problems became conspicuous - poverty among young workers in urban areas and the collapse of the local community in marginal areas. As the seniority wage system and lifetime employment were substitutes for the public social security system, public measures to deal with poverty remain inadequate. Now, the individualization of the family has advanced somewhat under compulsion as the rate of unmarried people and the divorce rate have climbed. The Japanese have a tendency to seek 'self-realization'; at the same time, they also want 'secure employment'. Thus, they are torn between individualization and the desire for security. What is now necessary is a more stable system that will ensure them adequate material and spiritual 'elbowroom' to allow them to make their own choices.

Study Design. A prospective nutritional intervention study for adult spinal deformity (ASD) patients. Objective. To investigate how a nutritional intervention affects the incidence of postoperative medical complications and the nutritional status. Summary of Background Data. The medical complication rate in ASD surgery is very high, and one risk factor is malnutrition. Nutritional intervention may improve the patient's nutritional status and reduce risk, but this is unexplored regarding ASD surgery. Methods. Malnourished patients (i.e., a prognostic nutritional index [PNI] score of <50) scheduled for surgery after November 2018 (Group I) received nutritional intervention consisting of nutritional guidance and supplements on the surgery day. The medical complication rates between Group I and Group NI (malnourished patients who underwent surgery between January 2014 and October 2018; historical controls) were evaluated. The nutritional status courses of Group I and Group NI2 (patients who did not participate in nutritional intervention after November 2018) were assessed. Results. Group I had 24 patients in (mean age, 70 yr), and Group NI had 69 patients (mean age, 68 yr). The mean intervention duration was 41 days. The preoperative PNI score did not differ between the groups, but there was a significant difference in medical complications incidences (Group I: 25%; Group NI: 53.6%; P ¼ 0.015). The nutritional status significantly deteriorated in Group I (PNI: 47-45; P ¼ 0.011) and Group NI2 (61 patients; mean age, 68 yr; PNI: 52-48; P ¼ 0.000), but the PNI changes were significantly smaller in Group I (DPNI: Group I: À1.9, Group NI 2: À3.5; P ¼ 0.027). Conclusion. Nutritional intervention with guidance and supplements reduced postoperative medical complications in malnourished patients. The nutritional status of ASD patients requiring surgery also naturally worsened, suggesting that ASD may contribute to malnutrition. Nutritional intervention may reduce the nutritional status deterioration.

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