2014/02/24抄読会

石川

Vaccine for prevention of mild and moderate-to-severe influenza in children.

N Engl J Med. 2013 Dec 26;369(26):2481-91. doi: 10.1056/NEJMoa1215817. Epub 2013 Dec 11.

4価不活化ワクチン(QIV)の有効性

P 複数国での3-8歳の小児

E QIV

C A型肝炎ウイルスワクチン

O

primary: rt-PCRで確定されたインフルエンザの数

secondary: rt-PCR陽性、ウイルス培養で同定された中等症～重症のインフルエンザ

・RCT, single-blind(observer-blinded)

・グラクソスミスクラインからfundあり

・Phase 3 study

・発展途上国

・差があると言っているが、下気道感染の発生率はそもそも両群で小さい

・倫理性

・本当に発症率はその程度？

患者はどちらを打っているか知っている→受療行動に影響

・そもそも受診していない人もいるのでは？

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山田

Association of coffee drinking with total and cause-specific mortality.

N Engl J Med. 2012 May 17;366(20):1891-904. doi: 10.1056/NEJMoa1112010.

コーヒー摂取と（全・原因特異的）死亡の関連

P AARP食事・健康調査の参加者(the National Institutes of Health-AARP Diet and Health Study)

E コーヒー摂取(1杯～6杯以上)

C コーヒー未摂取

O 死亡

コーヒー摂取量と死亡率は逆相関（多変量解析）

なし ＜1 1 2-3 4-5 ＞6

1.00 0.99 0.94 0.90 0.88 0.90

p＜0.001

non-hispanic white　90%程度

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富田

Effect of n-3 long chain polyunsaturated fatty acid supplementation in pregnancy on infants' allergies in first year of life: randomised controlled trial.

BMJ. 2012 Jan 30;344:e184. doi: 10.1136/bmj.e184.

オーストラリア　アデレード

P DOMInO trialに参加している妊婦（妊娠21週～出生）

E 魚油カプセル(n-3)

C 植物油

O 出生した児のIgE関連食物アレルギーの診断

T RCT

1歳時のIgE関連食物アレルギーの発症率は有意差なし

the n-3 LCPUFA 32/368 (9%)

control 43/338 (13%)

adjusted relative risk 0.70, 95%CI 0.45 to 1.09, P=0.12

percentage of infants diagnosed as having atopic eczema (that is, eczema with associated sensitisation) was lower in the n-3 LCPUFA group (26/368 (7%) v 39/338 (12%); unadjusted relative risk 0.61, 0.38 to 0.98, P=0.04; adjusted relative risk 0.64, 0.40 to 1.02, P=0.06). Fewer infants were sensitised to egg in the n-3 LCPUFA group (34/368 (9%) v 52/338 (15%); unadjusted relative risk 0.61, 0.40 to 0.91, P=0.02; adjusted relative risk 0.62, 0.41 to 0.93, P=0.02)

栄養法に違いはなかったか？

母乳栄養

普通ミルク

加水分解乳

2013/12抄読会

小川

Intramuscular versus intravenous therapy for prehospital status epilepticus.

N Engl J Med. 2012 Feb 16;366(7):591-600.

P 5分以上のけいれん持続、病院前、救急隊到着時けいれん持続

E ミダゾラム筋注

C ロラゼパム静注

O

 PO 病院救急外来到着時点での鎮痙（追加治療なし）

 SO endotracheal intubation, recurrent seizures, and timing of treatment relative to the cessation of convulsive seizures.

T double-blind, randomized, noninferiority trial

(the hypothesis that intramuscular midazolam was noninferior to intravenous lorazepam by a margin of 10 percentage points.)

病院救急外来到着時点での鎮痙（追加治療なし）

ミダゾラム筋注: ロラゼパム静注 = 329/448 (73.4%): 282/445 (63.4%)

(absolute difference, 10 percentage points; 95% confidence interval, 4.0 to 16.1; P<0.001 for both noninferiority and superiority).

The two treatment groups were similar

need for endotracheal intubation (14.1% of subjects with intramuscular midazolam and 14.4% with intravenous lorazepam)

recurrence of seizures (11.4% and 10.6%, respectively).

Among subjects whose seizures ceased before arrival in the emergency department, the median times to active treatment were 1.2 minutes in the intramuscular-midazolam group and 4.8 minutes in the intravenous-lorazepam group, with corresponding median times from active treatment to cessation of convulsions of 3.3 minutes and 1.6 minutes.

Adverse-event rates were similar in the two groups.

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山下

Metoclopramide in pregnancy and risk of major congenital malformations and fetal death.

JAMA. 2013 Oct 16;310(15):1601-11.

P metoclopramide-exposed and unexposed pregnant women

E metoclopramide＋

C metoclopramide－

O

 PO major congenital malformations overall, 20 individual malformation categories (selected according to power criteria), spontaneous abortion, stillbirth.

T Register-based cohort study

Denmark, 1997-2011.

From a cohort of 1,222,503 pregnancies, metoclopramide-exposed and unexposed women were matched (1:4 ratio) on the basis of age, calendar year, and propensity scores

 There were no significant associations between metoclopramide use and malformations overall (prevalence odds ratio, ) or

オッズ比 全体　0.93 [95% CI, 0.86-1.02]

20 individual malformation categoriesごとにみてもno significant associations (upper limit of 95% CI below 2.0 for 17 of 20 categories)

2013/11抄読会

水田

Premature death after self-harm: a multicentre cohort study.

Lancet. 2012 Nov 3;380(9853):1568-74.

P self-poisoning or self-injuryで救急受診した患者、年齢は問わない（Oxford, Manchester, and Derby, UK, between Jan 1, 2000, and Dec 31, 2007）

E

C

O age-standardised mortality ratios (SMRs) and years of life lost (YLL)

T cohort study

(Postcodes of individuals' place of residence were linked to the Index of Multiple Deprivation 2007 in England. Mortality information was supplied by the Medical Research Information Service of the National Health Service.)

Death was more likely in patients than in the general population (SMR 3.6, 95% CI 3.5-3.8)

males (4.1, 3.8-4.3)

females (3.2, 2.9-3.4)

Deaths due to natural causes were 2-7.5 times more frequent than was expected.

mean YLL(male) was 31.4 years (95% CI 30.5-32.2)

external-cause deaths was 40.2 years (40.0-40.3)

mean YLL(female) was 30.7 years (29.5-31.9)

external-cause deaths was 40.0 years (39.7-40.5)

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木村

Use of caffeinated substances and risk of crashes in long distance drivers of commercial vehicles: case-control study.

BMJ. 2013 Mar 18;346:f1140. doi: 10.1136/bmj.f1140.

P long distance drivers of commercial vehicles (New South Wales (NSW) and Western Australia (WA), Australia)

E substances containing caffeine＋

C substances containing caffeine－

O 事故

T Case-control study

交絡因子の調整: age, health disorders, sleep patterns, and symptoms of sleep disorders as well as exposures such as kilometres driven, hours slept, breaks taken, and night driving schedules.

結果

63% reduced likelihood of crashing (odds ratio 0.37, 95% confidence interval 0.27 to 0.50)

3% reported using illegal stimulants such as amphetamine ("speed"); 3,4 methylenedioxymethamphetamine (ecstasy); and cocaine