eMJA: In other journals - 4 November 2002

Caesareans and support

A 1995 Cochrane review concluded that providing women with continuous caregiver support during labour decreases the chance of caesarean delivery — an expensive prospect which North American researchers decided to test in their own environment of high intervention rates. Over two years, 6915 women from 13 hospitals with caesarean rates of > 15% were randomly allocated to receive continuous support from a specifically trained nurse or usual care. There was no difference in the rates of caesarean delivery between groups (12.5% v 12.6%). Neonatal and maternal outcomes (including the rates of postnatal depression at 6–8 weeks) were also similar.

JAMA 2002; 288: 1373-1381

The politics of suicide

Researchers from the University of Sydney say the risk of suicide in NSW is higher during periods of conservative government than when the Labor Party is in power. Their study looked at NSW suicide rates between 1901 and 1998 and correlated them with incumbent federal and state governments. After controlling for age, sedative availability, war and drought, suicide risk was lowest when the Labor Party formed both state and federal governments, and highest when a conservative party ruled at both levels (RRs 1.17 for men and 1.4 for women when “both conservative” was compared with “both labour”). Having a mixture of parties in power was associated with intermediate risk.

J Epidemiol Community Health 2002; 56: 766-772

More aspirin story

As the debate about the risks and benefits of aspirin continues, researchers from the United States have thrown their hat in the ring with the suggestion that aspirin protects women from lung cancer. Researchers from the New York University Women’s Health Study compared the aspirin use of 81 women who developed lung cancer during a median of 12 years follow-up with that of 808 matched controls. Exposure to aspirin in the month before enrolment in the study had no effect on the subsequent risk of lung cancer. However, women who stated that they had taken aspirin three or more times a week for at least six months were significantly less likely than those without such use to develop non-small-cell-lung cancer (but not lung cancer overall). The results are consistent with previous studies which found that non-small-cell lung cancers overexpress cyclo-oxygenase-2, an enzyme inhibited by aspirin and other non-steroidal anti-inflammatory drugs.

Br J Cancer 2002; 87: 49-53

A kidney down

A study conducted in Chennai, India, has found that people who sell a kidney for transplantation believe they are no better off for the transaction. Researchers used “snowball” sampling to identify 305 individuals (71% women) who had sold a kidney an average of six years previously. Ninety-six percent revealed that they sold the kidney to pay off debts, with only 5% reporting any altruistic intent. The average price paid was $US1070, and was often less than promised. Average family income reportedly declined by more than 30%, and the number of subjects living below the poverty line increased, following nephrectomy. Self-reported health status declined in 86%. Overall, 79% would not recommend that others sell a kidney.

JAMA 2002; 288: 1589-1593

Happy and healthy?

Despite the fact that it’s virtually impossible to do anything about your personality style, recently published research has linked health with personality and attitude.

A study from the Mayo Clinic ¹ followed up 447 patients who completed the Minnesota Multiphasic Personality Inventory (MMPI) between 1962 and 1965. On reanalysis of their MMPI answers according to an Optimism–Pessimism scale, 101 were rated as “optimistic”, 272 as “mixed” and 74 as “pessimistic”. Thirty years later the pessimists reported poorer physical and mental functioning (according to the 36-Item Short-Form Health survey) than both the optimists and the mixed group. A previous study by the same researchers found that optimists had a 50% lower risk of early death compared with those in a “mixed” group.

Meanwhile, another US study ² has examined the more complex attribute of cheerfulness (defined as a combination of optimism and sense of humour) in 1215 children. The children’s parents and teachers rated each child for possession of these traits from 1922 to 1923. By 1986, it emerged that the subjects who scored highly on the cheerfulness scale had higher mortality rates, which could be partially but not completely explained by their indulgence in more risk-taking behaviours, such as smoking, drinking and risky hobbies. The cheerful children were no more likely than their peers to have psychological problems, or to be obese, so the mediating factors remain uncertain.

1. Mayo Clin Proc 2002; 77: 748-753

2. Personality Soc Psychol Bull 2002; 28: 1155-1165