Shiga University

The objective of this study was to understand the descriptive epidemiology of childhood tuberculosis (TB) in Japan under the 2013 Bacillus Calmette-Guérin (BCG) immunization program modification. The median percentage of annual vaccination coverage for infants aged <13 months was 97.0 % during follow-up (2007-2022). The age at which most infants received their vaccinations was 3 months before 2013 and 5 months after 2013. During follow-up, the number of childhood TB notifications and annual incidence declined by approximately 60 % and 40 %, respectively. A multivariate-adjusted model analysis was performed by birth year to determine the association between childhood TB and the 2013 BCG immunization program modification. However, childhood TB was associated with age and BCG vaccination history but not with the 2013 BCG immunization program modification. This study represents a valuable resource for future research, elucidating the efficacy of BCG as well as the impact of BCG policies.

Comparative evidence on the effectiveness of romosozumab and teriparatide in preventing osteoporotic fractures remains limited. This study evaluated their effectiveness in fracture prevention.

This observational new-user cohort study used the DeSC Healthcare database, a nationwide claims database in Japan. Patients aged ≥40 years with osteoporosis, defined by International Classification of Diseases, 10th Revision codes or prior fragility fractures, who newly initiated romosozumab or teriparatide between March 2019 and August 2021 were included. The primary outcome was the major osteoporotic fractures within 1 year. Secondary outcomes included 2-years fracture incidence and individual fracture types. Cox proportional hazards models, weighted by inverse probability-of-treatment derived from propensity scores, were used to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs), accounting for patient- and facility-level confounders.

Among 35,547 observations (romosozumab: 9603; teriparatide: 25,944), the mean ages were 80.3 and 80.0 years, 85.2 % and 81.3 % were women, and 64.4 % and 71.9 % had a history of fragility fracture, respectively. The 1-year incidences of major osteoporotic fractures were 10.14 per 100 person-years (teriparatide) and 7.01 per 100 person-years (romosozumab) (HR: 0.80, 95 % CI: 0.71, 0.89). Romosozumab was also associated with lower rates of composite fractures over 2 years (HR: 0.81, 95 % CI: 0.72, 0.90); vertebral fractures over 1 and 2 years; and proximal humeral, distal forearm, and proximal femoral fractures over 1 year.

In this nationwide Japanese cohort, romosozumab use was associated with a lower incidence of major osteoporotic fractures compared to teriparatide over both 1- and 2-year follow-up periods among high-risk patients with osteoporosis.

There is no consensus on whether community social cohesion has positive or negative impacts on mental health. In this study, we hypothesized that strong social norms in highly cohesive communities might increase concerns about reputation, which could negatively affect mental health and help-seeking. We analyzed data from 23,672 adults aged 65 years or older from the 2019 wave of the Japan Gerontological Evaluation Study (JAGES). Cross-sectional multilevel analyses revealed that individual-level social cohesion-measured by community trust, reciprocity, and place attachment-predicted fewer depressive symptoms and lower reluctance to seek help. However, at the community level, social cohesion predicted higher concerns about reputation, which in turn predicted more depressive symptoms. Notably, this association was stronger among individuals with lower educational attainment, suggesting that they may experience greater reputational pressure within highly cohesive communities. These findings support our hypothesis that community social cohesion may be linked to negative outcomes due to reputational concern and highlight the paradoxical nature of social cohesion.