BMJ
お酒の飲みすぎ気をつけよう
Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study（BMJ 2017;357:j2353）
Design: observational cohort study repeated for 30 years, Setting: UK, community dwelling adults
P: 550 people, mean age=43（SD5.4）、not alcohol dependent screened by CAGE scale
O: Structural brain measures included hippocampal atrophy, grey matter density, and white matter microstructure. Cognitive function.
Results:
1. hippocampal atrophy
higher alcohol consumption related to hippocampal atrophy in a dose dependent fashon
higest risk= 30 units per week OR=5.8 (CI: 1.8 to 18.6), 14-21 units per week OR=3.4 (CI: 1.4 to 8.1)
2 higher alcohol consumption related to differences in corpus callosum microstructure and faster decline in lexical fluence.
3. no association was found with cross sectional cognitive performance or longitudinal changes in semantic fluence or word recall.
# 1 unit = 8g or 10ml of alcohol,
14 units の例： 600mlの強いビール 4杯、175mlのグラスワイン（14％）で5杯、など
14units per weekでも脳の萎縮のリスクは上昇、しかし認知機能との関連は認めず。
運動は認知症の発症と関連しなさそう
Physical activity, cognitive decline, and risk of dementia: 28 year follow-up of Whitehall II cohort study
BMJ 2017;357:j2709
Design: cohort study (mean follow up 27 years), Setting: civil service department in UK
P: 10308 people aged 35-55.
O: cognitive function, diagnosis of dementia
Results: no evidence of association
妊娠中の過剰体重は出生児の障害に関連するかも
Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons （BMJ 2017;357:j2563）
Design: cohort study
Setting: Nationwide Sweden registries
P: 1234957 liveborn singleton infants(2001 to 2014)
良くわからない出生時異常はまだ多い
Etiology and clinical presentation of birth defects: population based study(BMJ 2017;357:j2249)
Design: cohort study
Setting: USA
P: 5504 cases among 270878 births
Results: Definite cause was assigned in 20.2% (n=1114) of cases:. The 79.8% (n=4390) remaining were classified as unknown etiology
約80％は原因がわからない
RCTのバイアスに関する情報は時代とともに良くなっているが、インパクト低い雑誌はまだ要努力
Evolution of poor reporting and inadequate methods over time in 20 920 randomised controlled trials included in Cochrane reviews: research on research study(BMJ 2017;357:j2490)
Design: Mapping of trials included in Cochrane reviews
P?: Data from RCTs included in all Cochrane reviews published between March 2011 and September 2014 reporting an evaluation of the Cochrane risk of bias item. 20 920 RCTs (from 2001 reviews) published in 3136 journals.
Results:
|
|
Sequence generation |
Allocation concealment |
Blinding |
Incomplete outcome data |
|
Unclear |
48.7% |
57.5% |
30.6% |
24.7% |
|
High |
4.0% |
7.2% |
33.1% |
17.1% |
Higher journal impact factor: lower proportion of trials at unclear or high risk of bias.
Unclear risk of bias decreased over time, especially for sequence generation, 69.1% in 1986-1990 to 31.2% in 2011-14 for allocation concealment (70.1% to 44.6%).