A description of a pre-emptive typhoid Vi capsular polysaccharide vaccination campaign after the 2015 earthquake in Nepal and vaccine effectiveness evaluation.

BACKGROUND: A 7.8 R scale earthquake hit Nepal in April 2015 and caused about 9000 deaths along with damage to infrastructure, including the water and sewage system. Bhaktapur was one of the highly affected districts. A typhoid vaccination campaign (pre-emptive) was carried out among children who were living in the temporary shelters in this district. The assessment of vaccine effectiveness after a pre-emptive typhoid vaccine campaign following an earthquake has previously not been attempted in Nepal. OBJECTIVE: To describe the pre-emptive typhoid Vi capsular polysaccharide vaccination campaign and an evaluation of the vaccine effectiveness. METHODS: We conducted a pre-emptive typhoid Vi capsular polysaccharide vaccination campaign among children between 2 and 15 years of age dwelling in 23 temporary shelters in Bhaktapur district after the earthquake. Surveillance of clinical typhoid was carried out from 2014 to 2017 in Siddhi Memorial Hospital, the only hospital for children in the district. We calculated vaccine effectiveness using a case-control study design (clinical typhoid as cases and chest x-ray confirmed pneumonia as controls). RESULTS: Three thousand nine hundred sixteen children of age 2-15 years residing in the 23 temporary shelters in Bhaktapur received the typhoid Vi capsular polysaccharide vaccine between July and December 2015. 2193 children of age 2-15 years were admitted to the hospital during the study period and 260 (11.9%) were diagnosed with clinical typhoid. The numbers of children admitted with clinical typhoid decreased over the study period (105 in 2014 and 47 in 2017; P = 0.001). Overall vaccine effectiveness was calculated at 52% (95% CI -46 to 85%), and it was 87% (95% CI -25 to 99) among children less than 5 years of age. CONCLUSIONS: We successfully conducted a pre-emptive vaccination campaign against typhoid after the 2015 Nepal earthquake. The pre-emptive vaccination campaign appeared to be more effective among children less than 5 years of age. Further studies are needed to assess the effectiveness of pre-emptive use of typhoid vaccines in the emergency situations. We highlight the challenges of calculating vaccine effectiveness of a typhoid vaccine in an emergency setting.

Association of revision of Money Lending Business Act and suicide rate in Japan: An interrupted time series analysis.

OBJECTIVE: Debt problems are associated with suicide. In Japan, the Money Lending Business (MLB) Act was revised in December 2006 and fully enforced in June 2010 to reduce multiple debt problems. This study aimed to examine the association between the full enforcement of the revised act and suicide rates. METHODS: An interrupted time series analysis was used to the national registry data of death records between January 2000 and December 2016. Stratified analysis was conducted to assess the differences between gender and age groups. RESULTS: The effects of the full enforcement on the suicide rate were the greatest among men aged 40-64 years; after the enforcement, there was a significant decrease of -0.3085 per 100,000 persons in the level of the suicide rate (95% confidence interval [CI] -0.529 to -0.0881) and -0.0165 per 100,000 persons (95% CI -0.0215 to -0.0115) in the trend. Among women aged 40-64 and ≥65 years, an increase in the level of the suicide rate was observed after the enforcement. CONCLUSIONS: The full enforcement of the revised MLB Act was associated with decreased suicide rates, particularly among middle-aged men. Policy interventions for addressing debt problems may have the potential to prevent suicide.

Association of Birth Order With Mental Health Problems, Self-Esteem, Resilience, and Happiness Among Children: Results From A-CHILD Study.

Objective: This study aimed to investigate the association of birth order with mental health problems, self-esteem, resilience, and happiness among children aged 9-10 years. Methods: This was a cross-sectional study using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, which was a population-based study of children in fourth grade in public schools in Adachi City, Tokyo, Japan in 2018 (N = 3,744). Parent-rated Strengths and Difficulties Questionnaire (SDQ) and self-rated resilience, happiness, and self-esteem score were used to assess child mental health. Multiple regression analysis for continuous outcomes and logistic regression for dichotomous outcomes were used to examine the association of birth order with mental health problems, resilience, happiness, and self-esteem. The analysis was controlled for child sex, mother's age, mother's education, caregiver's depressive symptoms, household income, and living with grandparents. Results: Last-borns showed the lowest total difficulties score in the SDQ, while only children showed the highest (p < 0.001). The highest prosocial behaviors score was found among last-borns (p < 0.001). Resilience score was also highest among last-borns, followed by first-borns, middle-borns, and only children. The lowest happiness score was found among middle-borns. Self-esteem score did not differ by sibling types. These associations were similar in the adjusted model and dichotomized outcomes model. Conclusions: Differential impacts of birth order on child mental health, for both positive and negative sides, were found. Further research is warranted to elucidate the mechanism of the association between birth order and the development of behavior problems and the positive aspects such as resilience, happiness, and self-esteem among children.

Association Between Parenting and School Refusal Among Elementary School Children in Japan: Results From A-CHILD Longitudinal Study.

Objective: The aim of this study was to examine the association between parenting, including the parent-child interaction and child maltreatment in the first grade (6-7 years old), and school refusal in the second (7-8 years old) and fourth (9-10 years old) grades among elementary school children in Japan. Methods: Data were from the Adachi Child Health Impact of Living Difficulty (A-CHILD) longitudinal study conducted in 2015, 2016, and 2018 in Adachi City, Tokyo, Japan. A questionnaire was distributed to all the first-grade school children (N = 5,355) in 2015. Of the total 4,291 valid children (response rate: 80.1%), 3,590 and 3,070 children were followed up to the second and fourth grades, respectively. Caregivers responded to the questionnaire on the parent-child interaction and child maltreatment, including neglect, physical abuse, and psychological abuse in the first grade and school refusal in the second and fourth grades. We conducted multiple imputation for missing data. Multivariate logistic regression model was used for this analysis adjusting for child mental health in the first grade and sociodemographic characteristics. Results: Prevalence of school refusal was 1.8% (n = 64) in the second grade and 2% (n = 60) in the fourth grade. We found no association of the parent-child interaction and child maltreatment in the first grade and with school refusal in the second and fourth grades, respectively, after adjusting for covariates. Conclusions: Parenting, such as the parent-child interaction and child maltreatment, may not be associated with school refusal among elementary school children. Further longitudinal research is needed to elucidate other factors, such as peer relationships and school environment, which can affect school refusal.

Toothbrushing and School Refusal in Elementary School: A Longitudinal Study.

The aim of this study was to examine the association between toothbrushing frequency and school refusal among elementary school children. We used data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) longitudinal study conducted between 2015 and 2016 in Adachi City, Tokyo, Japan. A questionnaire was distributed to all first-grade children aged 6 to 7 years (N = 3697, follow-up rate: 86.2%). Propensity score (PS) matching was applied to collapse the known covariates on toothbrushing frequency in grade 1 on the association with school refusal in grade 2. Among the followed children, 2.4% showed school refusal in grade 2 (89 children) and 23.5% (870 children) brushed their teeth once or less than once daily in grade 1. After propensity score matching, children with toothbrushing once or less than once daily in grade 1 were 2.25 (95% CI: 1.25-4.05) times more likely to show school refusal in grade 2, compared with those with toothbrushing twice or more a day. Our findings suggest that toothbrushing once or less than once daily is an independent risk factor for school refusal among children. Oral health promotion to recommend toothbrushing more than once a day could prevent school refusal. Further intervention studies investigating the mechanism and causality are warranted.