Background/Aims: Despite the advent of advanced therapies, cases of so-called “difficult-to-treat” (D2T) ulcerative colitis (UC) persist. This study aims to clarify the epidemiological and clinical characteristics of patients with D2T UC. Methods: We conducted a nested case-control study using the Medical Data Vision Claims Database in patients with UC who began an advanced therapy (biologics, advanced small molecules, calcineurin inhibitors) from January 2018 through April 2023. D2T UC patients were defined as having 2 or more switches of advanced therapies, or as undergoing surgery for UC, within 2 years after the first advanced therapy. Results: Four hundred and one (16.7%) and 1,996 patients (83.3%) met the definitions of patients with D2T UC and non-D2T UC, respectively. After 1:1 matching by index year, 355 patients per group were included in the analysis. Multivariate logistic regression analyses, including sensitivity analyses based on follow-up period after the first advanced therapy, showed that a prescribed corticosteroid dose of ≥ 30 mg/day during the 6-month baseline period was associated with D2T UC. In D2T UC patients, median duration of the first advanced therapy was 99 days, and median number of advanced therapies per year was 1.7. The first advanced therapy was continued for 2 years in 78% of patients with non-D2T UC. Conclusions The proportion of D2T UC patients among UC patients starting advanced therapy was 16.7%. The factor most associated with D2T UC was the need for a corticosteroid dose ≥ 30 mg/day during the 6 months before initiation of advanced therapy.

Since the advent of bovine spongiform encephalopathy (BSE) in the United Kingdom in 1986, new BSE cases have recently become rare. However, in Japan and the United States, positive cases have started to be seen recently. The rise in BSE cases paved the way for the human form of this disease, the variant Creutzfeldt-Jakob disease (vCJD). The observed trends in the UK may be attributed to effective implementation of public health policies coupled with increased vigilance through advancement in science and technology, or they may well be a reflection of the natural disease progression. We aim to discuss the BSE chronology of events, and compare examination methods, costs and cost-efficiency, management, and public policies of Japan, Europe, and the USA.

Information security and assurance are an increasingly critical issue in health research. Whether health research be in genetics, new drugs, disease outbreaks, biochemistry, or effects of radiation, it deals with information that is highly sensitive and which could be targeted by rogue individuals or groups, corporations, national intelligence agencies, or terrorists, looking for financial, social, or political gains. The advents of the Internet and advances in recent information technologies have also dramatically increased opportunities for attackers to exploit sensitive and valuable information.Government agencies have deployed legislative measures to protect the privacy of health information and developed information security guidelines for epidemiological studies. However, risks are grossly underestimated and little effort has been made to strategically and comprehensively protect health research information by institutions, governments and international communities.There is a need to enforce a set of proactive measures to protect health research information locally and globally. Such measures should be deployed at all levels but will be successful only if research communities collaborate actively, governments enforce appropriate legislative measures at national level, and the international community develops quality standards, concluding treaties if necessary, at the global level.Proactive measures for the best information security and assurance would be achieved through rigorous management process with a cycle of "plan, do, check, and act". Each health research entity, such as hospitals, universities, institutions, or laboratories, should implement this cycle and establish an authoritative security and assurance organization, program and plan coordinated by a designatedChief Security Officer who will ensure implementation of the above process, putting appropriate security controls in place, with key focus areas such aspolicies and best practices, enforcement and certification, risk assessment and audit, monitoring and incident response, awareness and training, and modern protection method and architecture. Governments should enforce a comprehensive scheme, and international health research communities should adopt standardized innovative methods and approaches.

This paper discusses the history of emerging infectious diseases, risk communication and perception, and the Supercourse lectures as means to strengthen the concepts and definition of risk management and global governance of zoonosis. The paper begins by outlining some of the key themes and issues in infectious diseases, highlighting the way which historical analysis challenges ideas of the 'newness' of some of these developments. It then discusses the role of risk communication to public accountability. The bulk of the paper presents an overview of developments of the Internet-based learning system through the Supercourse lectures that may prove to be a strong arm for the promotion of the latest medical information particularly to developing countries.