疫学デザイン分類 観察疫学 分析疫学　　　　　　　　　　　　　　　　　　　生態学的、有病率 　症例対照　コホート研究 介入(実証)疫学　　　　　　　　　臨床、地域、集団、個人

望ましい評価デザイン 　　　事前調査　介入　事後調査 対象 対象 case 対照 対照 control

Effects of improved home heating on asthma in community dwelling children: randomised controlled trial BMJ 2008;337:a1411 Objective To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma. Design Randomised controlled trial. Setting Households in five communities in New Zealand. Participants 409 children aged 6-12 years with doctor diagnosed asthma. Interventions Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial. Main outcome measures The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV1). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child’s general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child’s bedroom were recorded hourly. Results Improvements in lung function were not significant (difference in mean FEV1 130.7 ml, 95% confidence interval –20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10°C (95% confidence interval 0.54°C to 1.64°C) and in the child’s bedroom of 0.57°C (0.05°C to 1.08°C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 µg/m3 v 15.7 µg/m3, P<0.001). A similar effect was found in the children’s bedrooms (7.3 µg/m3 v 10.9 µg/m3, P<0.001). Conclusion Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist.

無作為化した地域における断熱住宅による 健康較差に関する介入実証研究 研究目的は、既存家屋の断熱により、室内気温の増加と入居者の健康と心地よい生活を向上させることを明確にすること。 ﾆｭｳｼﾞｰﾗﾝﾄﾞの七つの低所得階層地域を七地域選定し、1350の家屋と4407 人の参加を得て、無作為に二区分した地域介入実証研究。介入内容は、基準retrofit　断熱である。 主要な効果指標は、家屋内の気温、湿度、エネルギー消費、鼻詰まり、学校の休み、医療機関受診と入院である。 主要な研究結果として、介入群では、対照群に比べて、冬期での寝室気温が0.5度増加し、湿度は、2.3%低下した。エネルギー消費は、対照より81%となった。寝室気温が10度以下は、毎日1.7時間少なくなった。 主観的健康感の低下群が、オッズ比が0.50（95% confidence interval 0.38 to 0.68)と低下し、同様に鼻詰まりオッズ比が(0.57, 0.47 to 0.70),自己申告の学校休みが、オッズ比が0.49, （0.31 to 0.80)、仕事休みが0.62, （0.46 to 0.83)と低下した。 受診回数オッズ比が0.73, 0.62 to0.87)、呼吸器の入院オッズ比が0.53,（ 0.22 to 1.29)であったが、統計学的な有意性は見られなかった。 結論として、家屋の断熱により、室内気温が暖かくなり、主観的健康感が高まり、鼻詰まりと呼吸器の入院が少なく、学校と職場の休みが少なくなった。

Epidemiology of acute rheumatic fever in New Zealand 1996–2005 Richard Jaine, Michael Baker and Kamalesh Venugopal Department of Public Health, University of Otago, Wellington, New Zealand Aim: Acute rheumatic fever (ARF) and its sequela chronic rheumatic heart disease remain significant causes of morbidity and mortality in New Zealand, particularly among Ma￣ ori and Pacific peoples. Despite its importance, ARF epidemiology has not been reviewed recently. The aims of this study were to assess trends in ARF incidence rates between 1996 and 2005 and the extent to which ARF is concentrated in certain populations based on age, sex, ethnicity and geographical location. Methods: This descriptive epidemiological study examined ARF incidence rates using hospitalisation data (1996–2005) and population data from the 1996 and 2001 censuses. Rates were compared by using rate ratios and 95% confidence intervals. Results: New Zealand’s annual ARF rate was 3.4 per 100 000. ARF was concentrated in certain populations: 5- to 14-year-olds, Ma￣ ori and Pacific peoples and upper North Island areas. From 1996 to 2005, the New Zealand European and Others ARF rate decreased significantly while Ma￣ ori and Pacific peoples’ rates increased. Compared with New Zealand European and Others, rate ratios were 10.0 forMa￣ ori and 20.7 for Pacific peoples. Of all cases, 59.5% were Ma￣ ori or Pacific children aged 5–14 years, yet this group comprised only 4.7% of the New Zealand population. Conclusion: ARF rates in New Zealand have failed to decrease since the 1980s and remain some of the highest reported in a developed country. There are large, and now widening, ethnic disparities in ARF incidence. ARF is so concentrated by age group, ethnicity and geographical area that highly targeted interventions could be considered, based on these characteristics. Key words: epidemiology; New Zealand; rheumatic fever.

家庭暖房による、子供喘息の無作為対象、対照試験効果 BMJ 2008;337:a1411 目的　ニュージーランド、汚染のない地区での家庭暖房効果として、小児喘息軽減効果を、無作為調査で実証することが調査目的。 対象：医師が喘息と診断した6-12歳、 409人 評価指標　　一秒間の肺活量、呼吸症状、服薬状況、 2005年冬に事前調査、次の年に健康状態、受療状況、環境面の評価指標：室温と二酸化窒素を4ヶ月間調査、子供部屋は、毎時間調査。 結果　FEV1 130.7 mlは、統計上有意差無し。学校欠席は、1.8日(95% confidence interval 0.11 to 3.13),少ない。喘息受診数は、 0.40 （0.11 to 0.62）回少ない。薬剤師相談は、0.25 (0.09 to 0.32)回少ない。主観的健康感の低下オッズ比は、 0.48, 95% adjusted odds ratio confidence interval 0.31 to 0.74)少なく、睡眠時間不足オッズ比は、0.55, 0.35 to 0.85)少なく、夜の咳オッズ比も (0.52, 0.32 to 0.83),少なく、呼吸気管症状オッズ比も0.77, 0.73 to 0.81少ない。 環境としては、温度が 1.10°C (95% confidence interval 0.54°C to 1.64°C)高く、子供部屋の温度は、 0.57°C (0.05°C to 1.08°C).高く、二酸化窒素は、 8.5 µg/m3 で 対照群の15.7 µg/m3, P<0.001)より少ない。 子供部屋の二酸化窒素は、 7.3 µg/m3 v 10.9 µg/m3, P<0.001であった。 結論：子供の呼吸器機能改善は見られないが、呼吸器症状が改善し、喘息症状も改善し、学校休みも少なく、医療機関受診も相談も軽減した。

我が国における住宅に関する 介入実証研究の現状 １９８３年から現在まで、医学中央雑誌検索で、原著論文なし。報告も見当たらない。 環境省が子供の異常行動の解明のために、10年間で600億円の予算を確保している。我が国、リスク因子探索研究がメイン。 森林療法では、介入実証研究が報告されている。